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I
^:i«^^Vv-.j' ' N
1
THE
NORTHERN
JOURNAL OF MEDICINE ;
MONTHLY SURVEY
OF THE
PROGRESS OF MEDICAL KNOWLEDGE
AT HOME AND ABEOAD.
SDITID BT
WILLIAM SELLER, M.D.,
VSLLOW OF THB BOVAL OOLUMS OP PHYSICIANS, LSCTimBR ON BfATNItlA IfNDIOA AND DirrSTICS,
AND
T. LINDLEY KEMP, M.D.;
WITH THB ASSISTANCE OF A BODY OF GENTLEMEN ENGAGED IN THE PRACTICE
AND TEACHING OF MEDICINE.
VOL. I.
EDINBURGH:
PUBLISHED FOR THE PROPRIETORS ;
AND SOLD BY OLIVBR & BOYD, EDINBURGH; DAVID ROBERTSON, GLASGOW; LEWIS
SMITH, ABERDEEN; SIMPEIN, MARSHALL, & CO., LONDON; W. CURRY, JUN., & CO.,
DUBUN; GAUGNANIi PARIS; HIRSOHWALD. BERLIN; AND ALL B0OKSELLER&
1844.
Printed by (Jliver it Boyd,
TwMddale Coart, Hifh StrMt-, Edinburgh.
THE
NORTHERN
JOURNAL OF MEDICINE.
No. I.— MAY 1844.
Part I.— ORIGINAL ARTICLES.
On the Employment and Action of Digitalis in certain Diseases
of the Heart. By William Henderson, M.D., Professor
of General Pathology in the University of Edinburgh.
A REMEDY so long and so habitually resorted to, and so much
prized, in the treatment of diseases of the heart, as digitalis, may
be supposed to have been so thoroughly studied, and to be so
weU understood, in all its therapeutic capabilities, as scarcely to
afford occasion or ground for remarks having any pretension to
novelty or importance ; and yet, a glance at the opinions which
are entertained of the manner in trhich its benefits are effected,
and at the indiscriminate and almost universal recommendation
of it in organic diseases of the heart, suffices to prove that some-
thing may still be added to the history of its operations, not
unworthy of being known. Or perhaps the matter may be more
correctly stated in a different way, so as that, while it may be
granted that the effect which digitalis produces on the heart is
thoroughly understood, it may be still questioned whether the '
manner in which different diseases of the heart are influenced by
that effect has been duly considered or recognised, — ^a mode of
putting the case which would make the proper title of this com-
munication, '' The action of different diseases of the heart under
the influence of digitalis."
Passing by the alleged temporary acceleration of its contrac-
tions, the heart may be said, in general terms, to have the fre-
quency of its motions lessened by digitalis. Such being the case,
it will hardly surprise any one who is sufficiently acquainted with
the very signal changes which some diseases of the organ pror
2 ON THE EMPLOYMENT AND ACTION OF DIGITALIS
duce on its construction as an hydraulic machine, that a frequency
of its action, which may be advantageous in certain conditions of
it, may be very much the contrary in others ; and yet the im-
portant inference which may thus be demonstrated by morbid
anatomy is almost universally overlooked in practice. My at-
tention to this circumstance was first suggested by Dr Corrigan's
excellent paper, in the Edinburgh Medical and Surgical Journal,
on Permanent Patency of the Aortic Valves. That judicious
physician had noticed that the employment of digitalis was not
so generally useful in that as in most of the other diseases of the
heart, and my own subsequent experience and observation en-
tirely concur with his. I do not mean to say that very
notable advantage is not derived from digitalis in permanent
patency of the aortic valves, but that beyond a certain degree its
characteristic operation is so much less beneficial than in the
other diseases of the heart in which digitalis may be employed,
or is actually so injurious, that it becomes a highly important
practical rule to abstain from the prolonged or repeated admini-
stration of it in the disease in question.
Patency of the aortic opening, at that period when the ven-
tricles are being filled, necessarily admits of regurgitation from
the aorta, the effects of which are an overloading of the left
ventricle, and gradually an enlargement of it — an enlargement
so great ultimately, if the patient survive long, as to exceed, often
to a great degree, that which occurs under any other circum-
stances. The greatest enlargement of the heart I have seen,
larger than any other on record, was the consequence of
permanent patency of the aortic opening. All the chambers of
the organ had become affected with excentric hypertrophy, and
to so great a degree that the weight of the empty heart amounted
to thirty-six ounces two drachms and a half, — above four times
the average weight of the healthy heart. Such being the
tendency and issue of that overloaded condition of the organ
which results from regurgitation from the aorta, it will be granted
that whatever increases the amount of the regurgitation must
accelerate the progress of the enlargement. That the less
frequently the heart beats, the greater will be the opportunity
for this regurgitation, is sufficiently obvious ; and hence it is that
the prolonged employment of digitalis cannot but be injurious
when the aortic valves are not competent for their office. To
the consideration of other expedients, common in the ordinary
treatment of organic diseases of the heart, yet unequivocally
IN CERTAIN DISEASES OF THE HEART. 3
improper in this, I may advert on a future occasion, and shall
content myself at present, in reference to what has just been
stated, with saying that, if true to the extent to which I believe
it to be true, its importance is very much enhanced by the facts
that permanent patency of' the aortic valves is one of the most
common of the valvular diseases of the heart, and is perhaps the
most easily distinguished during life.
What a priori discernment and practical observation concur
in showing to be disadvantageous in the disease which has been
specified, is capable of being proved by the same means to be
eminently useful in some other diseases of the heart, and in none
more than in those of the left auriculo- ventricular opening. To
these I confine my further remarks for the present.
Diseases of this opening, although of several kinds, produce
but two sorts of effects on the drculation ; — either, by merely
narrowing it, hindering the transmission of blood from the left
auricle into the ventricle, or, by rendering the leaves of the
mitral valve insufficient to close it, while the ventricle is con-
tracting, admitting of a regurgitation of blood into the auricle.
When either of these occurrences amounts to a considerable de-
gree, and is of long continuance, hypertrophy of the right
ventricle supervenes, and then it is that the sufferings from
dyspncea are developed, and that dropsical effusions are apt to
take place. The circulation through the heart is materially
impeded, and the lungs, — partly from this cause, and partly from
the augmented power of the right ventricle, — ^placed as it were
between two fires, become overloaded with blood, and distressed
with the sense of suffocation. And not only so, but the whole
venous circulation becomes retarded, and congestions occur in
distant viscera. Superadded to the mere mechanical imperfec-
tions which result from the diseases of the opening, and the
hypertrophy of the right ventricle, an increased frequency of
the actions of the heart very commonly attends, either as a
permanent occurrence, or as an occasional event dependent on
bronchitic attacks, and, usually, in proportion to this frequency
are the distress from dyspncea and the amount of the dropsy.
Those who are familiar with valvular diseases of the heart must
have remarked that a very moderate amount of bronchitis is
enough to excite much suffering from what is called difficulty of
breathing, but it is certainly not usual to find this ascribed to
its true cause. Impeded transmission of air into the cells of the
lungs is commonly considered the source of the evil, though the
4 ON THE EMPLOYMENT AND ACTION OF DIGITALIS
dyspnoea is often very great without there being any stethoscopic
evidence of such impediment ; and, that I am right in ascribing
it rather to the increased frequency of the actions of the heart,
appears from the facts that mere muscular exertion, by increasing
that frequency, suffices to produce or to aggravate the dyspnoea,
and that a diminution of that frequency through the instru-
mentaUty of digitaUs suffices to lessen or to remove it. The
reason why an acceleration of the pulses of the heart excites or
increases dyspnoea and dropsy in the diseases of the left auriculo-
ventricular opening is twofold. In the first place, it does so on
account of the hypertrophic condition of the right ventricle, and,
in the second, on account of certain occurrences at the diseased
opening. Thus, when there is narrowing only of that opening,
the more frequent closings of the valve cause a more frequent
interruption to the onward motion of the blood ; and, when there
is a patent state of the opening, a more frequent regurgitation,
and a greater amount of it in proportion to the quantity of
blood which has had an opportunity of passing into the ventricle.
Such being the natural effects of an increase in the frequency of
the actions of the heart, it is easy to understand how a diminished
frequency operates in reUeving the disorders which attend on
the diseases which have been referred to. This operation is
useful in several ways ; it moderates the force with which the
blood is propelled into the lungs, and, by the lengthened interval
between the contractions of the heart, it allows of the left ven-
tricle being more fully distended in the case of the narrowed
opening, while it lessens the frequency of the interruptions to
the passage of the blood, and, in the case of patency of the
opening, prevents the regurgitation from being so often repeated.
That these latter circumstances are not visionary, but real and
efficient, is manifested by the great change which is witnessed in
the size and force of the pulse at the wrist when the digitalis
has produced its full effect on the actions of the heart. From
being very small and feeble before the digitalis has been admini-
stered, the pulse becomes full and firm when the medicine has
reduced the number of the contractions of the heart to 40 or 60
in the minute. Coincident with this change, other important
improvements occur. The respiration becomes freer and easier,
the amount of urine increases, and the dropsy begins to disappear ;
improvements which are due to the bettered circulation through
the heart, and the consequent diminution of those mechanical
congestions which had embarrassed the lungs, and hindered the
IN CERTAIN DISEASES OF THE HEART. 5
action of the kidneys. In illustration of tHese yiews I subjoin
two cases, the one of narrowing of the left auriculo-ventricular
orifice, the other of regurgitation through it, and both with
hypertrophy of the right ventricle. It will be seen that in
each, as the heart beat more slowly, the amount of the urine
increased, and the dyspnoea and dropsy diminished. At first, for
a few days, in one case, squill and bitartrate of potash were con-
joined with the digitalis for the purpose of securing a diuretic
effect with more certainty ; they were speedily omitted, in order
to show the pupils of the hospital the action of digitalis alone.
I took the opportunity of stating, that I did not conceive the
digitaUs to act as a diuretic, in the common sense of the term, by
augmenting directly the functional activity of the kidneys, but
inihrectly in consequence of its lessening or removing the venous
congestion of these organs, in common with that of other viscera,
in the way I have described. At the same time it was stated^
that digitalis has been conceived to have the power of increasing
the secretion of urine by a more direct influence, perhaps a
stimulation of the kidneys, since it has appeared to augment the
quantity of urine sometimes in healthy persons, and has been
known to produce a similar effect on other secretions, occasionally
to a very considerable degree, — on the saliva for example. But
that in the cases in question the medicine could not be supposed
to have acted in this way, but in that which I have detailed
above, appeared to be proved by the continuance of the copious
secretion of urine so long as the effect of the digitalis continued
to be exerted on the heart, many days after the drug had been
omitted ; and by the decrease in the amount of urine which
occurred when the action of the heart rose to its previous
frequency.
Case 1. — Narrowing of the Left Auriculo-ventricular Opening.
Mary McDonald, a widow, aged 60 years. She was admitted
into the Infirmary on the 19th of February last, and fell under
my care on the 29th of that month. It had been ascertained
that twelve years before her admission she had been affected
with severe pain in the chest, for which she was bled and blis-
tered, and that since that time she had enjoyed on the whole
good health until about six weeks before her admission, when, as
she thought in consequence of exposure to cold, she became af-
fected with dyspnoea and cough. She had been previously sensible
of occasional palpitations of the heart, and about the time at
which she began to suffer, — ^but whether after the dyspnoea came
6 ON THE EMPLOYMENT AND ACTION OF DIGITALIS
on or not was not ascertained, — she became a£fected with general
dropsy.
The report of the 29th of February is as follows : — The ster-
num is prominent, the corresponding cartilages of the ribs not so.
The percussion-sound is pretty good in front, beginning to be
dull in connexion with the heart between the third and fourth
left cartilages, and laterally on the right side of the lower third
of the sternum, from which the dulness extends two inches to the
left of the bone. The respiratory murmur is superseded a Uttle
by mucous rattle on the right front. The percussion-sound is
dull on the left back inferiorly , nearly from the lower angle of the
scapula, but is moderately good on the right. The respiratory
murmur is absent over the dull space on the left. Pulse at the
wrist very feeble and irregular ; in the region of the heart not
particularly strong. At the wrist the pulsations amounted to 56
in the minute, and in the region of the heart to 72. She has
much dyspnoea ; respirations 26. The report on the 1st of March
is to this effect : — Urine amounts to ten ounces, is loaded with red
sediment, and has a density of 1023. Pulse in the region of the
heart is 104, at the wrist 58. It is very feeble and small, but
pretty regular, in the latter situation. Sounds of the heart are
free from murmur. Impulse moderate. On the 2d she was
ordered ten leeches to the sternum, and powders containing each
two-thirds of a grain of digitalis, two grains of squill, and ten of
bitartrate of potassa, of which one was to be taken every six
hours. She had also a draught for the night, containing some
muriate of morphia and sulphuric ether. She had at this time
considerable oedema of the lower limbs, and a good deal of
effusion into the left pleura,
March 4. The urine began to increase on the 2d, and in the
course of the last twenty-four hours has amounted to thirty-six
ounces. Breathing easier. GEdema nearly gone.
March 5. About seventy ounces of urine. Breathing much
improved. State of left side much as before. Pulse improved in
size and strength, — ^at the wrist 56, at the heart 90. All but
the digitalis to be omitted, of which a grain thrice a-day.
March 7. Urine 120 ounces. Pulses in the region of the heart
80, a strong followed quickly by a feeble one ; at the wrist 56, of
fair strength and size, and not very irregular.
On the 11th, the pulse was 40 at the wrist, full and firm ;
and continued from 40 to 42, full and firm, and the urine
usually from 30 to 90 ounces, till the 19th, though the digitalis
IN CERTAIN DISEASES OF THE HEART. 7
was omitted on the 12th. The pulse began to rise in frequency
after the 20th, and on the 1st of April was at 84, the urine
amounting to thirty ounces. On the 2d of April, the pulse was
90, — ^fluctuation and swelling had occurred in the abdomen, and
oedema in the lower limbs, and the breathing had become again
very difficult, — ^though the effusion into the left pleura, which
had disappeared, had not recurred, — and the urine had become
reduced to fifteen ounces. Two grains of nitre and one and a
half of squill were prescribed four times a-day, and on the two
following days the urine amounted to twenty-four and twenty-
six ounces. Digitalis in doses of a grain thrice a-day was sub-
stituted on the 4th ; and on the 7th the urine amounted to 64
ounces, while the pulse ranged between 80 and 92 ; and on the
10th to 100 ounces, the pulse being 50, of good size and
strength. On the 11th of April, the pulse was 48, the urine 104
ounces. The influence of the digitalis on the heart appeared
to decline afterwards ; and on the 15th the pulse at the wrist
was 60, small and irregular, in the region of the heart 80, and
the urine amounted to but 24 ounces. She desired to be dismissed
at this date.
Case 2. — Regurgitation through the left auriculo-ventricular
orifice, and hypertrophy of the right ventricle.
Mrs Blakie, aged 27 ; admitted into the Infirmary, March 6,
1844. Eight or ten years ago she was very subject to rheumatism,
which affected chiefly the lower extremities, but the lesser joints
in upper extremities also occasionally. About eighteen months
ago she was confined with her first child, the labour was tedious,
and required the aid of instruments for its completion. About
a fortnight after deUvery she had a severe inflammatory affection
within the chest, shortly after her recovery from which she
was sensible for the first time of palpitations in the region of
the heart, greatly aggravated on exertion, and accompanied by
a good deal of dyspnoea, and sense of constriction across the
chest. Since that time her sufferings have been gradually in-
creasing.
Exertion of any kind, especially that of ascending an emin-
ence, increases her dyspnoea so much as to oblige her to stand
still, and produces palpitation of the heart. Her pulse is 90
at the wrist, very small and feeble. The €xact extent of
dulness in the region of the heart cannot be ascertained, owing
to the fulness of the mammae. It begins, however,, fully half an
inch to the right of the lower half of the sternum, ascends as
8 ON THE EMPLOYMENT AND ACTION OF DIGITALIS.
high as the thu*d rib on the left side, and extends to the left
beyond its natural limits. There is a strong impulse over all
this surface, and also in the epigastrium; and also a strong
bellows murmur chiefly in the region of the left ventricle.
The second sound of the heart at the lower extremity of the
sternum, on the right side of the epigastrium, and also between
the second and third left cartilages, is preternaturally clear and
loud. Both external jugular veins are very turgid, and have
a sUght single impulse, synchronous with the contraction of the
ventricles. She has had some swelling of the face, lower ex-
tremities, and abdomen, for the last three weeks. There is a
purplish tinge of the countenance; urine said to be between
two and three pounds, but has not been kept ; density 1022 ;
distinctly coagulable by heat and nitric acid. A good deal of
mucous rattle at the lower part of right lung, where
the percussion-sound is not very satisfactory. She is or-
dered to have two-thirds of a grain of digitalis thrice a-day.
On the 10th, the pulse was 80, and fuller ; the urine 40 ounces ;
the breathing easier; and the oedema considerably less. On
the 11th, the urine was 68 ounces, of density 1015, and les»
coagulable ; the pulse 72, and of fair size and strength, — ^all the
dropsical symptoms diminished. On the 12th, urine 48 ounces,
pulse 72, of good size and strength. Nausea having occurred,
the digitalis was omitted, and she had some squill powder given
her for two days. On the 13th, the pulse continued of good
size, not exceeding 80, — ^the respirations were easy, and the
urine amounted to 58 ounces. She was dismissed in about a
week after, having experienced great reUef since her admission.
Latterly her complaints were returning, but family circum-
stances prevented her remaining longer.
Illustrations of Congenite Syphilis. By William Campbell,
M.D., Consulting Physician- Accoucheur to the Edinburgh
Maternity Hospital, and Lecturer on Midwifery, &c.
Though not a few opportunities occur to those toiling in the
same vineyard with myself, to satisfy them that a father, whose
system is contaminated with syphiUs, from this complaint having
been imperfectly eradicated, may so infect his oflfspring that it
shall die in utero, or if born alive, exhibit evidences of disease
ILLUSTRATIONS OF COMOENITE SYPHILIS. 9
at or some time after birth ; yet as this opinion is called in ques-
tion in a recent work of reputation,* I am induced to record the
following illustrations and remarks in support of a belief which
appears to me to have been long and well established. In 1823,
I was requested to attend, in her second confinement, Mrs C, the
lady of one of my brethren, then six months advanced in her
pregnancy ; and in a few weeks thereafter she was deUvered of
a male child, which Hved only eight hours. It presented no
morbid appearance, nor was its development less than that of
other foetuses whose residence in iUero was of similar duration.
No cause was assigned for the premature labour ; and I was now
informed that in her previous confinement the birth was also
premature, and that the infant survived only a few hours. In
the summer of 1824, I again attended this lady, when labour
supervened in the seventh month ; but on this occasion the foetus
was dead ; and from the extent of decomposition, and the infor-
mation derived from the parent, hfe must have been extinct for
more than ten days.
After these repeated misfortunes I resolved on an inquiry,
from which, owing to its delicate nature and the respectability of
the party, I had hitherto been deterred. The gentleman was a
young physician, and I ascertained that about six months previous
to his marriage with a young and amiable lady, he contracted
what appeared to himself and another junior member of the pro-
fession, a chancre. After employing ^e usual means, and con-
sidering the disease removed, he married. At the period of this
investigation there was not in either parent the least evidence of
syphilis in any form, — ^nay, both the individuals enjoyed perfect
health. In the foregoing case the gentleman was salivated ; the
lady also, as a matter of precaution, took a grain of calomel daily,
for eleven days, when the gums became aflFected to a much greater
extent than was intended. When the uterus was restored to its
unimpregnated condition, this lady again conceived, advanced to
the usual term of gestation without any tendency to premature
uterine action, and was deUvered of a vigorous male infant, free
from any syphilitic taint. Therfe was no more issue, for the
father died within a year from this birth;
I shall add but one more illustration, for siich oases are so
familiar to those of our brethren who devote their attention to
obstetric practice, that it would be superfluous to multiply them.
* Acton, Complete Practical Treatise on Venereal Diseases, p. 404.
B
10 ILLUSTRATIONS OF CONGENITE SYPHILIS.
In the autumn of 1843, I was consulted hj a lady from the
country, ten weeks advanced in her fourth pregnancy. Her first
infant was born in the early part of the eighth month of gestation,
was delicate, and lived eleven days. The delivery was attended
by a profuse discharge of liquor amnii. Her second birth hap-
pened in the seventh month, the infant surviving only an hour
and a half; and her third delivery happened in the sixth month,
when a foetus much decomposed was produced. After careful
inquiry, I satisfied myself that the lady never had any syphilitic
symptoms. Before I could decide on a suitable plan of treatment,
I requested an interview with the husband, from whom I learned
that about 23 years previously, and 17 years before marriage,
he had syphilis repeatedly ; and though assured to the contrary,
his impression always was that the disease had not been com-
pletely removed. These parties were apparently in perfect health.
I determined on exhibiting mercury to the gentleman, and he was
accordingly twice mildly salivated. But I hesitated at first to order
this medicine for the lady, lest the uterus might be excited, and
the ovum thrown oflF. Proceeding, however, upon the belief,
from what happened in her three former gestations, that the
foetus would be destroyed unless mercury were exhibited, and
that there was a chance the medicine, under prudent manage-
ment, might not occasion premature expulsion, I determined to
salivate the lady also. She was twice salivated, after which she
enjoyed excellent health ; and imtil the seventh month she ad-
vanced in her pregnancy without even a tendency to premature
uterine action. From tihis date, however, there were frequent
threatenings of premature expulsion, which repeatedly required
the abstraction of blood, and doses of from 80 to 100 drops sol.
mur. morph. to allay them. At the close of the eighth month
labour supervened, when a hving, healthy, small female foetus
was produced.
I have also met with repeated instances where, after minute
inquiry, and acknowledged contamination on the part of the fe-
male parent, I have been satisfied that she alone was to blame
for a series of misfortunes such as have now been related. In
several of these instances, the mothers, after positively denying
ever having had syphilis, afterwards paid me confidential visits,
to inform me as a profound secret, that they had had this disease
before marriage. These individuals, likewise, after the admini-
stration of mercury, had a living progeny.
In the present age, when it is fashionable with some of our
ILLUSTRATIONS OF CONGENITE SYPHILIS. 11
brethren, in their morbid avidity to acquire a character for ori-
ginality, to deny even the evidence of their own senses, we have
been told that the production of a living healthy progeny, in
such cases as those now referred to, is to be ascribed, not to the
eradication of syphilis, but to the induction of some other change
in the system. All that need be said, however, in reply to this
objection is, that such facts as the foregoing, since they must
have been observed by every practitioner extensively engaged
in this department of the profession, are of too stubborn a nature
to be set aside by reasoning or sophistry. From the Graafian
vesicle being a part of the female parent, and the ovulum after
fecundation being dependent for its development on the fluids
derived from her system, it will readily be admitted that the
progeny will be healthy or diseased according to the condition of
the materials furnished for its support. But we cannot so easily
comprehend the transmission of syphilis from the male parent to
the product of conception. But although we can no more explain
this point than we can the transmission of mental peculiarities,
sunilitude of features, gout, scrofula, phthisis, cancer, and super-
numerary fingers and toes, yet it would be absurd to call its
reaUty in question, when such glaring and numerous facts are so
frequently brought under our notice.
Dr Acton is also sceptical as to the influence of syphilis in de-
stroying the foetus or producing abortion ; and in support of his
belief he refers to information derived from prostitutes, who
were inmates of the Parisian Venereal Hospital during his at-
tendance at this institution. Though ready to do justice to every
man's honest opinion, I would say that information from the
source referred to is, to say the least, questionable ; secondly,
that the field for observation was far too limited, considering that
on an average not more than six prostitutes in one thousand con-
ceived in the course of one year, according to the investigations
of Duchatelet ;♦ and, thirdly, that opinions based on such data
cannot be put in competition with the experience of men who have
been half a century or more engaged in practice. That in occa-
sional instances a foetus much contaminated with syphilis will be
retained to the full period of utero-gestation, and even appear
plump and healthy for days or indeed weeks after birth, must
• " En r^BUmant toutes ces reponscs qui m'ont 4i4 faites, et ce que j'ai trouvtf
dans quelques livres anciena et modemes, j'ai du titer cettc conclusion, que miUe
prostitutes fournissent h peine six accouchemens dans le courant d*une ann^e."
Tome L p. 230.
12 ILLUSTRATIONS OF CONGENITB SYFHILIS.^
have been noticed by all obstetric practitioners of experience ;
but such cases only constitute the exceptions to the general rule.
This circumstance, though undeniable, we cannot explain ; nor
yet why abortion should generally happen when the foetus is
sickly or has been destroyed by syphilis. All we know is, that
when the deyelopment of the foetus is interrupted, or its life
becomes extinct, it is a law in the economy of the reproductive
system of the female for the uterus to be sooner or later excited
to rid itself of its contents.
In some instances there is reason to believe that the virus is
increasing in activity, from the circumstance of the first foetus
produced not only being born alive, though premature, but con-
tinuing to live for some time, while several succeeding produc-
tions are not only stillborn and decomposed, but have been
expelled at an earlier period of gestation. In other cases again,
as all these circumstances arp reversed, the disease would appear
to be exhausting itself. The following case would seem to prove
that in a twin pregnancy, the virus sometimes progresses very
differently in each foetus, though both are exposed to the same
source of contamination. In the summer of 1823, a pupil of
my class delivered a woman in Rose Street of twin males at the
full time. The first was dead and much decomposed, while the
second was living, plump, and apparently healthy. We were
unable to account for this remarkable difference for some weeks,
when the secret was revealed by the living infant exhibiting
imequivocal evidences of syphilis; and shortly thereafter the
female parent also bepame affected with secondary symptoms.
I have seen several instances in which a diseased infant con-
taminated a perfectly healthy nurse. In one of these cases
where there were ulcers on the child's mouth, the breasts and
thereafter the whole system of the nurse were affected, and that
in so short a period of time as to be scarcely credible. On a
Sunday forenoon this individual received to nurse a twin infant
born of a parent who had been contaminated by her husband,
but in whom the complaint was thought to have been completely
removed by the use of the hydriodate of potass ; and although,
from the disease having appeared in the child, it was returned
to its mother on the Thursday following, the nurse was never-
theless contaminated ; the mammae became affected with copper-
coloured blotches, and the nipples surrounded by chops and
small ulcers.
In infants, at birth, syphilis shows itself under various forms.
ILLUSTRATIONS OF CONGEXITE SYPHILIS. 13
Some, as may be gleaned from the foregoing observations, are
i^ell developed, apparently healthy, and continue so for some
days or even weeks, when the pelvic limbs suddenly become
iadistinctly marbled, and if the mischief, as is very apt to hap-
pen, be not recognised, the child may be carried off after a few
days in convulsions, without exhibiting any other evidence of
syphilis. These are most insidious cases, from the indistinct
evidences of contamination, and from our not probably recognis-
ing their nature until after an investigation subsequent to the
infant having been cut off. In a second case the infant is imper-
fectly developed, presents the appearance of old age in miniature,
a sallow emaciated aspect, numerous Jarge pustules scattered over
the surface, ulcers on the lips and angles of the mouth, and
hoarseness of the voice. The pustules may be flat or prominent,
suppurate quickly, desiccate without buj^sting, and are soon con-
verted into dark crusts. Unless this variety be actively and
promptly attended to, the little patient is very apt to perish.
A third form in which syphilis shows itself in infants at or soon
after birth, and which, as far as my observation enables me to
speak, is the most frequent, is by the genitals being pervaded
by an extensive excoriation, which attracts little attention until
scaly copper-coloured blotches are seen on the nates and soles of
the feet, whence they extend to other points of the pelvic
extremities, as also to the groins and umbilicus. A great part
of the surface is at last pervaded by copper or livid coloured
blotches ; which, on the face and neck are dry, and covered by
mealy exfoliations ; while on every other region of the body
they are humid. On the head the hair appears like down,
though on other parts of the body it be natural. At length the
external mucous tissues become affected, as the lining of the
eyelids, nose, and mouth, and of the vagina in female children.
An ichorous discharge may flow from the nostrils in both sexes,
and from the vagina in the female ; and in one instance I have
seen this happen also in a premature male infant, whose mother
died from syphilis in less than a fortnight after delivery.
Cases attended with pustules at birth, much affection of the
mouth, and a considerable degree of hoarseness, require a very
guarded prognosis.
It is scarcely necessary to recommend that those children
should be reared by their parents, to prevent secrets of so deli-
cate a nature being disclosed, and the disease being communi-
cated to a hired nurse, who might afterwards institute proceedmgs
14 ILLUSTRATIONS OF CONOENITE SYPHILIS.
in a court of law for the recovery of damages. I must express
my decided disapprobation of all attempts to rear such infants
artificially, since they are generally so delicate that they are
almost certain of being lost under such management. And for
the r^noval of syphilis, I must say that, however suitable the
water-gruel system may be found in adult subjects, it would be
most reprehensible to rely on it for the extinction of the virus in
mere infisuits, or even in older children. There are various pre-
parations of mercury which may be used with safety and effect ;
but I have almost invariably preferred calomel. By some of
our brethren we are advised to limit the exhibition of mercury
to the nurse; but I am not aware that there are any good
grounds for this preference, neither am I prepared to say from
observation that it can be relied on. As, however, when this
agent is judidously administered, it is perfectly safe, and as it
must be more satisfactory to subject the child also to its influence,
I. have invariably acted on this principle.
The blue mass, hydrargyrum cum creta, and mercurial inunc-
tions to the soles of the feet, are all safe. I commence with doses
of a quarter of a grain of calomel, and two grains of creta
prseparata, once daily for the first ten days ; and thereafter the
quantity of calomel is progressively increased to a quarter of a
grain twice each day. The disease disappears rapidly imder the
influence of this medidne ; but nevertheless it is most difficult
effectually to eradicate the virus ; wherefore, I have made it a
rule invariably to continue the medicine for three weeks after
every vestige of discoloration has vanished. I have seen
ptyalism only once in a child in consequence of the use of
mercury. When the nurse feels the child's mouth unusually
warm, the medicine should be discontinued for a few days, lest
convulsions might arise from irritation ; a little mild laxative
should be ordered; and during congenial weather, the Uttle
patient should be taken into the open air. Should the calomel
excite diarrhoea, the medicine must be left off, and a dose of the
tincture of hyoscyamus, with warm bath, ordered at bedtime. I
have no faith in the exhibition of iodine in such cases ; for in
every instance in which I have known this medicine employed,
the disease returned.
EDINBUBOH, 4 PiCARDV PLACE, Jprtl 1844.
I>''1H XtANH CASt or IT.HFfiUATlOS uK TI!K AiiiaA
FATAL HEMORRHAGE FROM PERFORATION CUE* THE AORTA. 15
Case of Fatal Hemorrhage from Perforation of the Aorta by
False Teeth impacted in the (Esophagus. Bj James Dunoan,
M.D., Fellow of the Royal College of Surgeons, L. and E.,
one of the Surgeons to the Royal Infirmary, Edinburgh.
Calder, aat. 22, Edinburgh, March 9, 1844, had lost
his two superior anterior incisors when a boy by an injury re-
ceived when playing at ball. Being a dentist's workman, he
had, to conceal the loss, made at his spare hours artificial substi-
tutes which he had worn for the last three months. These were
intended to be removed at night, and in consequence of this, as
well as to prevent them from being seen, he had made the gold
plates, by means of which they were attached to the adjoining
teeth, as httle projecting as possible, compatible with the retain-
ing them in position. The consequence was, that their grasp of
the adjacent teeth was but slight, and they could be displaced
with ease. His master had repeatedly warned him of the dan-
ger attending the wearing them during sleep, and recommended
him always to remove them. He had, however, neglected this
precaution, and on the 28th February last, he had gone to rest
with them as usual. In the morning the teeth were amissing ;
and after a fruitless search for them amongst the bed-clothes, he
became convinced that he must have swallowed them. He was
further confirmed in this opinion by the dijficulty in swallowing
which he experienced, and by the sharp pain wliich he suffered
when the attempt was made. He was naturally much alarmed
by the accident, and in consequence applied to Mr Syme for
assistance. Mr S. passed a probang, and detected a foreign
body in the oesophagus, considerably below the cricoid cartilage,
and much beyond the reach of the ordinary forceps used for ex-
tracting foreign bodies from the gullet.
Mr S. now recommended his removal to the hospital, and
when there introduced a probang with threads passed through
the bulb, the other ends being retained in the hand, trusting that
if the bulb could be carried beyond the foreign body, it might be
entangled by them, and thus removed. Nothing, however, was
detected, and it was believed that it had found its way into the
stomach, — ^an opinion which was rendered the more probable by
the fact, that the difficult deglutition was by no means so great
as previously. So considerable indeed was the relief, that the
young man requested permission to leave the hospital the same
16 PATAL HEMOBRHAGB FROM PERFORATION OF THE AORTA.
evening. It was thought unsafe to comply with this request,
and he remained in hospital nine days, still suffering from the
fixed pain already alluded to, and occasionally spitting small quan-
tities of blood, but without complaining of much difficulty in
deglutition. The pain was consequently regarded as merely the
effect of some injury inflicted by the foreign body during its
passage downwards, and it was thought unadvisable to make any
farther examination during that period. From some cause or
other he left the hospital on the evening of the 9th day, and
returned to his own home.
Next morning, the 9th of March, I received a hurried call
from his mother, who had been much alarmed by an occurrence
which had taken place shortly before I had been sent for. She
stated that her son had risen from bed, and that in crossing the
room towards the window, he had become suddenly faint and
giddy, and had vomited a mouthful of blood. He was immedi-
ately removed to bed, and complained of a feeUng of great
weakness. I called upon him as soon as possible, and found
that during the absence of his mother he had slept a Uttle, but
still complained of great debihty, and of some shght difficulty in
breathing. His face was pale, and the skin rather cold, but
the pulse was of moderately good strength. From his descrip-
tion of what had taken place, I was led to beUeve that the
foreign body had been dislodged from its situation, and that it
was possibly within reach of the forceps, with which I had pro-
vided myself. I accordingly requested him to sit up by the side
of his bed, to enable me to make the necessary examination.
This he did with ease, and without much assistance, expressing
great anxiety to have something done to relieve him. The act of
depressing the tongue, to enable me to introduce the forceps,
produced vomiting, and a mouthful of dark fetid blood was
discharged. This was immediately followed by another but
much larger quantity of fluid of the same description, perhaps
about eight or ten ounces, and the false teeth were heard to rattle
against the vessel into which it was received. The patient was im-
mediately aware of this, and his friends were overjoyed at what
had taken place. Another mouthful of the same fluid was then
ejected ; an interval of a few seconds elapsed, and then a mouth-
ful of bright arterial blood was discharged ; a second, and a third
followed, the lips became livid, the pulse at the wrist ceased, the
patient gave one or two convulsive sobs, and expired.
An inspection of the body was readily obtained from the
BY FALSE TEETH IMPACTED IN THE (ESOPHAGUS. 17
friends. It was evident from what had taken place, that some
artery of large size had been perforated, but it was of com'se
impossible to say, previously to the dissection, what vessel had
been injured. The following were the appearances met with
at tho post-mortem examination : — The pharynx, the oesophagus,
and stomach, along with the carotids, subclavians, and arch of
the aorta, were removed entire, a Ugature having been previ-
ously thrown around the duodenum to prevent the escape of the
blood which had accumulated in the stomach, and so enable
us to form an estimate of the quantity wliich had been lost.
The oesophagus, stomach, and duodenum were found distended
with pretty bright arterial blood. The quantity could not be
measured ; but in the opinion of those present at the examination.
Professor Henderson, Mr Shand, Mr Reid, and myself, there
could not be less than eight or ten pounds. Tl^e pharynx and oeso-
phagus were laid open by an incision posteriorly, carried as low as
the cardiac orifice of the stomach. About 4^ inches from the rima
glottidis there was an ulcerated perforation of the anterior part
of the oesophagus, of about |ths of an inch in length and three
lines in breadth, passing obUquely upwards from the right to the
left side. The edges of the perforation were rounded, and
there was considerable surrounding injection of the mucous mem-
brane. By this opening the probe could be readily passed into
the aorta ; but the latter vessel was not laid open at the time, it
being thought better to immerse it for a day or two in spirits before
doing so. On laying open the aorta subsequently, a perforation
of about the size of a large crowquill was found about half an inch
below the origin of the left subclavian artery. The opening
was irregular in form, the edges everted, and at the lower par^
there was a pretty firm adherent coagulum. There was httle or
no vascular injection around this opening; The artery was
otherwise perfectly healthy.
I have annexed a sketch of the false teeth, along with another
showing the point at which the aorta was wounded. The gold
plate to which the teeth were attached was pretty large, adapted
to the shape of the palate immediately behind the incisor
canine and bicuspid teeth on either side, with projections corre-
sponding to the spaces between these teeth. The two last of these
projections on both sides were large and pointed, with almost a
cutting edge. The space between the two terminal projections
measured one inch and f ths, and the breadth of the plate behind
the incisors measured fully f ths of an inch. One could scarcely
c
18 FATAL HEMOBRHAOS FROM PERFORATION OF THE AORTA
conceive a more dangerous weapon, or one more likely to be
followed by fatal consequences, than that I have just described,
when lodged in the situation in which this one must have re-
mamed from the time of the accident, in order to have produced
the extent of ulceration met with on dissection. Its form readily
explains how it could not be felt, on the second introduction of
the probang, and oflfered no resistance to the passage of the in-
strument downwards. From the curve which it describes, and
from the stretching of the oesophagus between its two terminal
pomts, ample space must have been left for the passing of the
instrument; and from the manner in which it must have got
impacted after the first passmg of the probang, it would present
superiorly an edge not much exceeding in thickness that of an
ordinary sheet of writing-paper, so that the bulb would readily
glide over it without any resistance being met with.
In every point of view the case was an exceedingly alarming
one. If the teeth were allowed to remam in the oesophagus,
they could scarcely fail to induce fatal consequences ; and if they
passed into the stomach, the result would in all probability have
been the same, although very dangerous bodies are recorded as
having passed the whole length of the intestinal canal without
injury. Even had they been within reach of the forceps and
grasped by them, or had they been entangled by the threads
attached to the probang, their removal must have been attended
with very great danger, and might have proved instantaneously
fatal from the laceration of the important parts in the vicinity.
This case also affords an instructive example of one of the many
modes in which foreign bodies lodged in the oesophagus may
prove fatal, and inculcates the necessity of removing them as
early as possible when their removal can be effected.
Foreign bodies lodged in the oesophagus may lead to fatal conse-
quences in a variety of ways. When large, the first danger to be
dreaded is that of suffocation : this may take place instantaneously
before assistance can be afforded, and many cases are recorded in
which death has been produced in this manner. Should the foreign
body not be so large as to induce asphyxia, but remain impacted
in the oesophagus, various other results may follow. Inflammation
of the surrounding parts, leading to suppuration, may supervene,
and the foreign body thus being set free, may either descend
into the stomach, or may be rejected by the mouth along with
the purulent matter. Extensive suppuration of the surrounding
soft parts may on the other hand take place, and may, as has
BY FALSE TEETH IMPACTED IN THE (ESOPHAGUS. 19
not unfrequently occurred, lead to fatal consequences. Numer-
ous cases of this description are recorded, amongst others one by
Hofer, in which an abscess formed, and gave way into the chest,
death being the consequence.
Sir G. Ballingall has kindly communicated to me the case of
a soldier under his care in IncUa, in which death followed pretty
extensive gangrene of the surrounding parts. The man, on one
of the anniversaries of the king's birthday, when in a state of
intoxication, was eating his curry hurriedly, and in doing so
swallowed a portion of bone. The probang was passed, but
nothing could be detected. He remained in the hospital for ten
days, and then left it, but returned some time afterwards and
died. On dissection, the bone was found impacted in the gullet,
and the surrounding soft parts were in a state of gangrene.
In some few cases, the foreign body, after inducing suppuration
of the soft parts in the neck, has escaped externally on the spon-
taneous giving way of the abscess, or has been removed by in-
cision. One or two are recorded, in which the trachea has been
perforated by ulceration, and in this manner also the accident
may lead to a fatal result. In some few instances the foreign
body has formed a pouch for itself, and has remained there for
years, and afterwards been ejected by vomiting. One or two
cases are related in which the foreign body had been expelled
after the lapse of fourteen or sixteen years.
Death by hemorrhage, as in the case I have related, is not so
rare as I was led to beheve, before consulting the Uterature of
the subject. Many cases in which this has occurred are met with
in different works, the hemorrhage having followed perforation
by ulceration of the different large vessels in the vicinity at
periods more or less distant from the date of the accident. In
the Dictionnaire de Medecine, 1840, three cases are referred to
as having terminated in a similar manner to the one I have
related ; one by Martin, in the case of a soldier who had been
in the habit of swallowing pieces of money for wagers : these he
generally passed by stool, but at last he suffered from his folly.
Fifteen days after one of his exploits, he perished from vomiting
of blood; and on examination, the coin, which had not been
passed, was found to have penetrated the aorta, nearly at the
* same point as in the case I have recorded. — The two other
cases, the particulars of which I have not been able to
obtain, are related by Wagret, and Saucerotte. — The carotid
has been wounded in several instances. One is referred to in
20 FATAL HEMORRHAGE FROM PERFORATION OF THE AORTA
the same work as recorded by Dumoustier : I append another
as related by M. Begin, Surgeon Major at the Val-de-Grace.
" A soldier, while eating his soup, swallowed a piece of bone,
which stuck in the oesophagus. Attempts to push it on towards
the stomach were made, and seemed to be successful. Soft and
liquid food could now be taken without difficulty, and a probang,.
upon being introduced, readily reached the stomach. The
patient seemed to labour under no further inconvenience. He
left the hospital, but in the course of a month he returned
again, complaining of a sharp pain in the left side of the neck.
By the employment of antiphlogistics his ailment was removed,
and he left the hospital once more. The pain, however, which
never entirely left him, except for short intervals, became again
severe ; the patient returned for the third time to the hospital,
not, indeed, for the particular accident in question, but for a
gonorrhoea which he had contracted. Every thing seemed to be
going on well, when he suddenly threw up large quantities of
blood, perhaps to the amount of seven pounds. The hemor-
rhage presently ceased, but the next day it returned, and proved
fatal. On examining the body, there were found in the oesopha-
gus, about its upper third part, two parallel ulcerations ; that on
the right side nine lines in breadth, and that on the left twelve.
Opposite the latter there was an adhesion between the oesopha-
gufi and the corresponding part of the carotid. In this vessel,
moreover, erosion had produced a small opening, about a line
in diameter, which proved to be the source of the hemorrhage."
Guthrie relates a case, in his work on the arteries, in which
both carotids were wounded from swallowing pins, a soldier
having done so in order to get his drill-sergeant into a scrape.
Another is related by Mr Bell of Barrhead, in the Medical
Gazette, February 10, 1843, in which the right carotid was
perforated by a needle, which had been accidentally swallowed.
The pulmonary artery has been wounded, in one case com-
municated by M. Bernast of the Toulon Hospital to M. Begin.
" A young soldier thought he felt, while eating soup, that he
had swallowed a sharp bone, or a pin ; consequent to which he
experienced a pungent, lancinating, and occasionally insupport-
able pain. On entering the hospital, he was treated with an-
tiphlogistics, but without success ; the pain increased, and kept
the unfortunate patient in restless misery. Nausea at length
supervened, and he threw up some ounces of blood. Eventu-
ally he was seized with convulsions, and he died on the eighth
BY FALSE TEETH IMPACTED IN THE (ESOPHAGUS. 21
day. On opening the body, a large quantity of blood was found
in the chest, especially in the right side. The heart and aorta
were sound ; but on turning aside the pulmonary artery, there
was found in front of the CBsophagus a flattened, sharp-pointed
bone, indented on one of its edges, and^ resembling one of the
bones of the nose. This had produced an opening in the
oesophagus, and a corresponding, though very minute one, in
the pulmonary artery, at the spot where this vessel divides in
order to be distributed to the lungs. The point of the bone
was seen in actual contact with the lesion." — From the London
Med. Gazette, 11th May 1833, p. 175.
The right subclavian has also been wounded in one case, as
related by Mr Kirby in the Dublin Hospital Reports, vol. ii. —
In this case the right subclavian rose from the left side of the
arch of the aorta and passed to the right behind the oesophagus.
It is possible that many other cases may be on record, but I have
not happened to meet with them.
I have said, that even had the foreign body in this case
passed into the stomach, death might, and in all probability
would, have been the consequence. — I might refer to many in-
stances confirmative of this, in which the patients have per-
ished from hemorrhage, or from obstruction or perforation of
the intestines, but I do not consider it necessary to allude
further to these at present.
In the accompanying plate, a indicates the situation of the
perforation ; b par vagum ; c arteria innominata ; e left carotid ;
g left subclavian ; m a representation on a somewhat diminished
scale of the false teeth.
Case of Imperforate Hymen. By A. Webster, M.D., Physi-
cian to the Dundee Royal Infirmary, &c.
On the 8th of September 1843, M. C, mill-worker, aged 20
years and 11 months, consulted me regarding a small and
hard tumour situated a little below the umbilicus. On inquiry
I learned that this tumour had only recently attracted attention,
and that it did not cause much uneasiness, although it was painful
to the touch. The girl was plump and of a healthy appearance,
and the manmiae were well developed ; the abdomen was rather
prominent, and she had never menstruated. For upwards of
22 CASE OF IMFEBFOBATE HYMEN.
two years, however, she had been subject to periodical attacks
of pain about the loins, which generally lasted for days, and
were accompanied by a sense of weight and bearing down in the
pelvic region ; and latterly to these symptoms there had been
added difficult micturition and constipation ; the bowels being
with difficulty acted upon even by strong purgatives. On ex-
amination of the external organs of generation they appeared
normal and fully developed, but, within the labia, there existed a
strong membrane which completely shut up the entrance to the
vagina; this membrane was vascular and bulged outwards, as
do the membranes in child-birth, when they first begin to
separate the labia. On pressing against it, the feeling communi-
cated to the finger was that of a bag containing fluid. Having
thus satisfied myself that the case was one of imperforate hymen,
I next day, in presence of Mr Ross, house-surgeon to the
Dundee Boyal Infirmary, made an incision from the pubes to the
fourchette of about an inch and a half in length, and gave vent
to upwards of 8 lbs. of a thick brick-coloured fluid. This opera-
tion afforded great and inmiediate relief, while at the same time
the abdomen became much diminished in size, and the hard
tumour below the umbilicus entirely disappeared. I now passed
my fore-finger into the vagina, which felt as large and relaxed
as does that of a woman immediately after delivery of a child at
the full period ; the uterus, however, did not feel enlarged, as
the OS uteri was as small as in the virgin state. A roll of lint
was introduced into the vagina to prevent union of the incised
edges, which was withdrawn and re-inserted repeatedly for
about a week, till the cure was complete. After this I lost
sight of my patient, and as she had left her former lodgings, it
was not without difficulty that I discovered her a few days ago. I
then learned that about five weeks after the operation she
menstruated freely, and that she had continued to do so regularly
till within the last seven weeks ; and this latter suspension she
accounted for, by informing me that she had been three months
a married woman, and now considered herself pregnant ; her
first sexual intercourse was not attended by pain or difficulty.
Dundee, 20th Feb, 1844.
CASE OF CONGENITAL ULCERATION AND GANGRENE. 23
Case of Congenital Ulceration and Gangrene, By T. B. W,
Potts, M. D., Edinr., M. R. C. S. E., &c.
In July 1843 my professional assistance was requested by Mrs
C, a young woman then about the seventh month of her third
pregnancy, and apparently in the enjoyment of excellent health.
On the 17th of August, I was summoned to attend her in her
accouchement ; every thing went on most favourably, and she
was delivered of a male child after an easy labour of four hours.
On examining the infant with a view to ascertain its true uterine
age, I felt assured that it had not attained its full term by at
least three or four weeks. I also observed something seriously
wrong with its left foot. After having secured the cord and
paid the necessary attentions to the mother, this member was
more minutely examined, and a large ulcer was found on the
front of the foot, extending from the inferior part of the tibia and
fibula to the metatarsal bones ; the upper and lower portions of
the sore were in a gangrenous state ; and the ulceration had pro-
ceeded so far that the lower ends of the tibia and fibula were
exposed, as also some of the tarsal bones. A line of demarcation
commenced to form on the second day after birth, just above the
upper edge of the sore, but the child sunk on the sixth day. We
are left in doubt as to the cause of this affection ; but the question
appears to be, whether was it caused by disease — contamination
of the system, or by injury, strangulation, or pressure by the
cord. The mother admitted having contracted syphilis from her
husband previous to the birth of her two former children, who
are both alive, and apparently perfectly healthy ; but since that
period she has had no symptoms of the disease — so far showing,
that if syphilitic contamination be the cause of the affection
above detailed, it does not necessarily attack every child born of
the same parents, even although no steps have been taken to
eradicate the disease. Had the cord been firmly entwined around
the hmb, it might by long-continued irritation have produced
ulceration ; but neither the funis nor the limb exhibited marks of
pressure having been exerted. I may add, that the quantity of
liquor amnii was very large indeed ; and had the foetus gone on
until the full time, it would in all probability have been born
with one foot only. In consultation with one of my brethren, it
was deemed prudent not to interfere with the knife, as the child
appeared very weakly and delicate, and but Uttle hope of benefit
from an operation could be entertained.
St Aubixs^ JerseT; March 1844.
24 BR LYON PLAYFAIR ON SLBBP,
On the Functions of Oxygen in the Production of Natural Phenomena in the
Animal Economy. — ^I. Sleep, and some of its concomitant Phenomena,
Being the Substance of a Lecture delivered at the Royal Institution ofMan^
Chester. By Lyon Playfair, Ph. D., F. G. S., &c. &c.
The researclies of Liebig have lately shown that much information may
be obtained regarding the processes of life in the animal economy, even
when these cannot be subjected to direct experiment. Thus he has thrown
considerable light on the phenomena of motion, by applying to their eluci-
dation chemical laws, which analogy led him to expect would come into
operation during the exhibition of these phenomena. But there are many
other processes, to which he has not devoted attention, but which seem to
be explicable on the principles which he has so ably established. One of
these — ^the subject of Sleep— is of great importance in its relations to medi-
cal practice, and yet very little is known of its cause, or of the chemical
state of the body during its occurrence. Park, in his able Memoir ** On
the Causes of Sleep and Dreaming," has pointed out the errors of those
physiologists who preceded him in investigations on this subject ; but he
has not succeeded in doing more than establishing that certain physiological
states of the body offer inducements to sleep, without showing in what
manner these contribute to the production of a quiescent state of the -mind.
He considers that the true causes of sleep are, tlie periodical diminution in
the action of the heart, and simultaneous relaxation of the vessels of the
brain, by which a slower though fuller circulation of blood through the
brain is effected. But this merely describes a physiological state of the
body, without showing in what manner that state favours the quiescence of
the mind. It therefore does not furnish an explanation of sleep, but merely
points out the condition of the body which induces the repose of the mind.
A more accurate definition is therefore desirable, in order that we may
fully understand the circumstances which predispose to sleep, or occasion
wakefulness.
I shall attempt in this paper to show what chemistry seems to point out
as the probable cause of sleep, and of its concomitant phenomena, more
with the object of drawing attention to the subject, than with a view to
insist on the perfect accuracy of the chemical definition. Chemists are too
apt to fall into the sad error of converting the animal body into a laboratory ;
and therefore it is the duty of the physiologist to watch their steps nar-
rowly, and prevent the evils which may arise from this error. On this
account, I wish the views here given to be looked on with suspicion
and only accredited so far as they stand in unison with the acknowledged
experience of medical practice.
The production of animal heat, according to the chemical view of the
subject, is due to the union of oxygen with certain constituents of food, or
with the tissues already formed; The camivora depend wholly on the
waste of the muscular tissues for the maintenance of the heat of their bodies^
for the flesh on which they subsist is destitute of the unazotized organic
constituents which are employed in supporting the proper temperature of
the herbivora. Liebig has gone far to prove that the oxidation, or waste of
tissues in the camivora, takes place only when the vital powers are em-
ployed in the execution of a movement required by the will — at a time,
therefore, when they are not engaged in resisting the encroachments of
chemical affinity, represented in the body by the oxygen contained in
AND SOME OF ITS CONCOMITANT PHENOMENA. 25
aiierial blood. He has also shown that the waste of the muscular tissues
of the herbivora is effected under similar conditions. According to this
theoty, there cannot be a movement in the body, without a corresponding
waste (oxygenation) of matter in the organ subjected to motion. The
circulation of blood in the body, and the constant conversion of venous into
arterial blood, afibrd an abundant supply of oxygen to replace that expelled
from the system in the excretions.
Whilst the animal receives a quantity of food sufficient to restore the
matter carried off by oxygen, there are exhibited no peculiar phenomena.
But when it is deprived of food, as in the case of starvation, the changes of
matter which occur in the system are very characteristic and worthy of
attention. As the oxygen of the blood does not now meet food, with which
to unite, it seizes upon the vital tissues themselves, and effects their destruc-
tion. The sufierer now becomes rapidly emaciated, and the urine is observed
to contain an excessive quantity of the products which result from a waste
of the tissues. After this emaciation has proceeded for some time, the sub-
stance of the brain begins to yield to the destructive action, and, according
to the rapidity of its waste, excited action or delirious paroxysms ensue.
Then the heart becomes enfeebled, the blood flows less quickly than it did
before, the delirium subsides, and the patient dies from exhaustion. The
phenomena observed in fever, and produced, according to chemists, by the
entrance into the body of a substance already in a state of oxidation, either
as a specific contagion, or as malarious matter, are precisely of a similar
character. The point in its progress, bearing upon our present subject, is
the increase of force in the involuntary organs, which in time passes over
to the voluntary organs, and to the brain, producing as in the former case
delirious paroxysms.
The great distinction between animal and vegetable life is volition :
vegetables, not being possessed of volition, are constantly engaged in increas-
ing their fabric ; and, therefore, when volition ceases in the animal, it is
aptly said to have a vegetative life, for the vital powers are wholly employed
in increasing the mass of the body. Sleep is the time when an animal
becomes assimilated to a vegetable. Physiologists have shown that the
two most marked points during sleep are diminished respiration and de-
creased circulation. They are agreed that, towards the evening, or at the
lapse of a certain number of hours of work, the involuntary organs, the
heart and lungs, lose their wonted activity, and sufler a periodical diminu-
tion of action. Blumeubach describes the case of a patient trepanned, in
whom the brain was observed to sink during sleep and enlarge on waking,
obviously arising from the circulation being diminished in the former state
and increased in the latter. The consequence of this diminution is, that
less oxygen is taken into the system. Hence the proportion of venous
blood is increased, and the waste caused by arterial blood diminished. The
skull beuig a close cavity, must contain a larger proportion of venous, if
there be a diminution of arterial blood in the body. It is the latter alone
which can cause the waste of the brain, for venous blood has already parted
with its oxygen to materials met with in its course.
Matter in a state of inertia can never manifest the existence of a power.
Its motion alone shows that some power is in operation. If the portion of
matter used as the organ of manifestation be placed in such a condition as to
render that manifestation impossible, there is no evidence to the external
world that power was exerted. It has been perfectly demonstrated, that
every manifestation of power in the voluntary organs is accompanied by a
26 DR LYON PLAYFAIR ON SLEEP,
change in the matter of which they consist. The changed matter being
nowAinfit for vital structures is separated from the body. MQller and all
other eminent physiologists are of opinion that the same change takes place
in the brain, the organ of the mind. In fact, the contrary opinion involves
such violation of analogy, that its adoption, unless founded on the strongest
grounds, is inadmissible. We look upon a spot attentively ; it gradually
waxes dimmer, until it finally disappears. We think upon a particular
subject ; in time our thoughts are less clear, soon they become strangely
confused, and we are obliged to give up the attempt at concentration, by
thinking on a subject quite different from that which first engaged our
thoughts. This of course implies that the organs of manifestation have be-
come in part destroyed, and that the mind cannot manifest itself to the
world, until the impau*ed organs have attained their proper integrity ; for
it cannot be conceived that the mind, disconnected with matter, could suffer
exhaustion. This involves, it is true, the idea that different parts of the
brain are employed in different manifestations, but we know that as fiir as
sensation and intellect are concerned, this is the case, and probability indi-
cates a still more minute division. If, therefore, the brain suffer changes, as
do the other organs of the body by their exercise, there is as much necessity
for repose in the action of the brain, as there is for a vegetative state of
existence to reinstate in their full integrity the organs of volition. Hence
the necessity for that quiescent state of the mind known as sleep, when its
manifestations cease. The waste of cerebral substance could only have
been occasioned by oxygen, which is the only ultimate cause of waste, as
far as we are aware, in the animal economy. A deficiency in its supply
would therefore retai'd waste, and allow vitality to remodel its impaired
structures.
Such then is the state into which the body is thrown by the periodical
diminution in the action of the heart and lungs. The less rapidly that the
heart beats, the less rapidly can the blood be aerated, and the oxygen-
bearing fluid can be supplied to the brain. The slower that the lungs act,
the slower must oxygen enter the system to supply the diminished circula-
tion. And as the brain in sleep is not in a state in which it can change,
from a deficiency in the supply of oxygen, the consequence is (if it be ad-
mitted that the manifestation of thought and sensation is accompanied by
changes in the material substance of the brain), that the manifestations
of the mind are prevented, and it becomes no longer apparent to the
external world.
This, then, is Sleep. But if the theory be correct, it must be able to
explain the various circumstances which occasion or act as predisposing
causes to the production of this state, and if it fail in the explanation of any
of these, then is the theory imperfect ; but if it explain more of them than
the other theories usually received, such as those of CuUen, Blumenbach,
Park, and others, it deserves to be considered as a nearer approximation to
the truth, and the cases which it fails to comprehend may be included as
our knowledge advances.
The first point demanding consideration is, how it happens that a recum-
bent posture is favourable to sleep. Park justly ascribes this to the dimin-
ished pressure of the blood on the heart* The weight of the column of blood
from the head to the heart, estimated by Hales as equal in force to five
pounds, is removed, and thus its distending force is diminished. The heart
now relaxes, and the blood therefore is sent less slowly through the system.
Having, by the horizontal posture assuihed, acquired a retarded flow, the
AND SOME OF ITS CONCOMITANT PHENOMENA. 27
blood now comes less rapidly in contact with the oi^gans of respirationy on
which the same posture has produced a diminished action, and thus the
quantity of arterial blood in the body becomes diminished. Though,
therefore, all the vessels in the brain remain as fiill as they did before, yet,
by the deficient supply of oxygen, or, in other words, of futerial blood, and
by the retarded circulation of that which does exist in the cavity of the
skull, the causes of waste are diminished, and therefore, according to the
theory, sleep is produced. For the same reason, sleep ensues when the
aorta of an animal is tied, or when arterial blood is removed in lai*ge quan-
tity from the body by excessive bleeding. Bichat has shown that when
venous blood is withdrawn from a vein and projected into an artery, sleep
ensues^ amounting to asphyxia, or even to death. The later researches of
Dr Kay, now Dr Kay Shuttleworth, have proved that part of the results
obtained by Bichat might have been due to an increased pressure on the
brain ; but Dr Kay's observations, while they modify, do not set aside the
experiments of the former physiologist.
Any thing which removes the oxygen from the blood will in the same
manner cause sleep. This is particularly apparent in the debauch of a
drunkard. The drunkard takes alcoholic liquors with the production of
two opposite effects. At first his heart beats rapidly, the blood flows more
quickly, and he enters into that stage of fever which I described at the out-
set of the paper, in which the rapidity of circulation causes such an enor-
mous supply of oxygen to the brain, that its substance wastes so rapidly as
to become unfitted for the seat of the intellect, and delirium ensues. But
even while this delirium is at its height, the vapour of the alcohol is pene-
trating by diffusion every part of hb body. Its hydrogen and its carbon
are converting arterial blood into venous by depriving the former of oxygen,
which is its essential characteristic. The delirium now subsides ; but the
alcohol carries on its work of depriving the blood of oxygen, and the latter
now not reaching the brain in quantity as it did before, prevents change in
its substance, and the drunkard falls down in deep stupor or sleep. To re-
store him from this state, we withdraw the combustible fluid from the sto-
mach by means of the stomach-pump, and by ammonia and other stimulants
endeavour to excite respiration and circulation, in order that the alcohol
may be more i^edily consumed.
The action of alcohol diflers from that of opium or narcotics ; because
the permanent eflect of the latter, whatever the first transitory effect may
be, is to diminish the action of the heart and lungs, and therefore the sleep
thus occasioned is brought about by causes exactly similar to those which
in the natural state of health produce ordinary sleep.
The tendency to sleep in different animals is in inverse proportion to the
amount of oxygen consumed by them, and to the amount of carbonic acid
produced. Thus, reptiles and the naked amphibia produce, relative to their
weight, according to the experiments of MiiUer, one-tenth the amount of
carbonic acid evolved by mammalia, and one-nineteenth that of birds. We
have no numbers to express the tendency to sleep of these animals, but it
IS known that reptiles are peculiarly liable to be in a state of torpor or
sleep, while birds are, on the contrary, wakeful animab. A reptile, such as
a frog, will exist in a state of torpor for twelve hours in an atmosphere of
pure hydrogen gas, while birds die in the same number of seconds with the
ordinary symptoms of asphyxia. Hydrogen gas, when respired with air,
gives a tendency to sleep, as shown by the experiments of Allan and Pepys,
probably owing to the conversion of arterial into venous blood, as in the
28 DR LYON PLAYFAIR ON SLEEP,
case of alcohol. The same circumstance of a diminished supply of oxygen
to the hlood, which induces sleep in reptiles, acts also in different mamma-
lia in the promotion of this state, according to the relatiye size of their-
lungs. The same circumstance seems to operate in a like way with differ-
ent men.
The only explanation which I have seen of the tendency to sleep after a
heavy and excessive dinner is that first promulgated, I helieve, hy Macnish,
who ascrihes it to the drafting away of a large amount of sensorial or nervous,
power from the hrain to complete the digestion of the excess of food in the
stomach. This implies the necessity for considering the first act of digestion
as an act of vitality, of which, to say the least, there are great douhts. But
the drafting of sensorial power, that is, as I take it, of power connected
with the operation of the mind — for, if not, its removal could not favour
the quiescence of the latter — is a mode of explanation which must be con-
sidered entirely hypothetical. I am not aware that an inducement to sleep
is in general experienced when a small quantity of an indigestible food is
taken into the stomach, and yet this ought to be the case according to the
view of Macnish. The tendency to sleep is occasioned when the stomach is*
too much distended by an excess of food (or if it do occur with a small
quantity of an indigestible aliment, then there is an excessive flow of arte-
rial blood to the stomach to assist in the more rapid oxidation of its coat,
which the German chemists have dignified as the formation of a peculiar
substance termed pepsin). The consequence of this distention is, that the
diaphragm which separates the intestines from the heart and lungs is pushed
upwards against the latter, encroaching upon the space which ought to
be occupied by them, thus preventing their free play, or, in other words,
depriving the blood of its proper supply of oxygen, and therefore producing
sleep. A person subject to sleep after dinner experiences a sensation of
cold, obviously arising from the diminished oxidation in his body. If this
cold continue, sleep is prevented ; because it excites — as cold generally does
—the respiratory organs to greater activity, and this activity acts as an an-
tagonist to sleep, or in &ct neutralizes the effects arising from the pressure
of the diaphi-agm against the lungs. Hence it is that such persons draw
their seats towards the fire. The warmth of the fire prevents the increased
action of the lungs by preventing a diminution in the temperature of thei
body, cmd therefore the lungs are not excited to increased action, and sleep
ensues. Hence, also, a gentle walk after dinner removes the tendency by
accelerating the play of the lungs, which now, by their increased action,
introduce sufficient oxygen into the system to prevent sleep. It is alsa
possible, as has been suggested to me by Mr Noble, that the increased flow
of arterial blood to the stomach after a heavy meal may cause a tendency
to sleep by withdrawing a corresponding quantity from the brain. The;
effect occasioned by the pressure of the diaphragm on the lungs until the
distention has ceased, is analogous to the more permanent effects produced
in very fat individuals. It is well known that very fat people are peculiarly
prone to sleep. The fat accumulates around the viscera, pushes up tha
diaphragm, and lodging around the heart and edges of the lung^ the lattet
by all these causes are compelled to play in smaller space, and soon becomo
permanently contracted. Hence, any cause which occasions diminished re*
spiration in such an individual will cause him to fall asleep, by diminishing
further the supply of oxygen to the system. The mere diminution in the
action of the lungs produced by sitting often occasions sleep in such persons.
In their case, the further protrusion of the diaphragm cdter meals almost
AND SOME OF ITS CONCOMITANT PHENOMENA. 29
uiYariably produces sleep. This is more marked in animals fattened for
the butcher. Pigs in the last stage of fattening exhibit this disposition in a
marked manner. After distending their stomachs with food, they give a
few ineffectual attempts at an active respiration, and £Edl into deep sleep.
The cause is the same as that first stated, namely, the pressure of the dia-
phragm against the lungs ; this prevents a proper supply of oxygen from
entering the system. Macnish was not wrong in his observation that the
sensorial power became diminished in the brain after a heavy dinner ; but
he mistook the effect for the cause, when he attributed the tendency to sleep
to the abstraction of this power. The diminution of the quantity of arterial
blood in the cavity of the skull appears to be the true cause of sleep in
this case ; and the decrease of sensorial power is a consequence, but not the
cause, of the sleep. It cannot be considered that the absence of a disposition
to sleep in some kinds of dropsy, in which the diaphragm is pushed against
the lungs, forms a decided objection to the view given of the tendency to
sleep after dinner ; because the contraction of the lungs being gradual, na-
ture suits itself to the circumstances by exciting a more rapid respiration.
Besides, the results occurring in the diseased state ought not to be considered
strictly parallel to those we would expect if the body were in health.
Perhaps I might venture to throw out this view as explanatory of the
winter sleep of hybematmg animals. In summer these animals accumu-
late fat in their bodies ; probably from the very fact of the smallness of
their lungs, which prevents the entrance of a sufficient supply of oxygen
to convert the unazotized portion of their food into carbonic acid and*
water. This fat, accumulating around the caul and loins, pushes forward
the diaphragm against the lungs. The fat also gathers round the edges of
the heart and lungs, and still further diminishes the space in which the
latter ought to play. Thus respiration is greatly retarded, in consequence
of which the animal falls asleep. This explanation accords with the in-'
teresting experiments of Saissy, who has shown that hybemating animals
decompose most air when they are in a state of greatest activity, that they
respire less during autumn as their fat accumulates, and that the respira-
tion becomes extremely feeble at the commencement of their winter sleep,
and ceases altogether when that sleep becomes profound. Spallanzani
has confirmed this fact, showing that there must be a cutaneous respiration,
for a small amount of carbonic acid is evolved, although the lungs cease-
to act. During the long'-continued sleep of the hybemating animals, the
longs play slowly ; in fact, several minutes often elapse between each
respiration, and the diminished state of oxidation is proved by the reduced
temperature of their bodies, which is generally not higher than four
degrees above that of the surrounding medium. In this state they have been
aptly compared to lamps slowly burning, their fat being the oil, and the
lungs the wick of the lamp. It is true that cold is favourable to the-
production of hybernation, and this is not in opposition to the theory ;
but Berthold has shown that hybernation takes *place in a warm as well as
in a cold atmosphere. If our view be correct, very fat animals should-
show a similar disposition to sleep, and it is knovm that a pig in its last
stage of fattening is rarely awake. Instances have occurred, in which
pigs, being placed in a favourable condition, have actually proved their
capability of being in a state of hybernation. Thus Martell describes the
case of a fat pig overwhelmed with a slip of earth, which lived 160 days
without food, and was found to have diminished in weight in that time^
more than 120 Ibs.^ an instance quite analogous to the state of hybernation/
30 DR LYON PLAYFAIR ON SLEEP,
It is well known that intense cold is a powerful inducement to sleep.
This effect is partly mechanical. The vessels containing blood become con-
tracted ; the blood itself becomes more dense, and flows more sluggishly ;
and consequently the brain, from the operation of both these causes, is less
freely supplied with arterial blood. The theory therefore explains the result.
This is the case only with extreme cold, for a slightly reduced tempera-
ture, instead of promoting, often retards deep. But here also the theory
is true to itself, for slight cold is known to increase the rapidity of res-
piration, and therefore causes an increased supply of oxygen to the
system. Slight cold cannot act in this way so easily in the case of
hybemating animals as in others, because the accumulation of fiit, and
enlargement of the glands in the chest and neck, press upon the res-
piratory nerves and prevent their proper action.
If, then, it be true, that before the mind can manifest itself to the ex-
ternal world, its organ, the brain, must be in the position to unite with
oxygen, any thing which tends to withdraw it from that position must
cause an impairment of the faculties, even if the cause do not operate
with sufficient intensity to produce sleep. This is very apparent in the
cold stage of ague, when the blood circulates slowly through the body.
In fever, on the other hand, when the blood rushes in a torrent through the
system, the mind becomes acutely sensible to every perception. In fever
also we find little disposition to sleep, and when this does occur, it is
restless and disordered, accompanied by troubled dreams. The chemistry
of this disease affords us an instructive lesson with regard to phenomena
resulting in the case of health. There are two states into which organic
matter passes; — decay, being the change which ensues when a large
supply of oxygen is present ; putrefaction, when that supply is
deficient. During the waking state in fever, decay or eremacausis pro-
ceeds rapidly, and delirium, the consequence of this state, appears when
the heart beats quickly and the lungs play strongly ; in other words, when
the greatest supply of arterial blood is sent through the system. But dur-
ing night, when the oxygen-bearing blood is decreased in quantity by dimin-
ished respiration — when oxygen is therefore not present in quantity sufficient
to combine with the changing matter — then it passes over into putrefac-
tion, indicated by the petechie which then appear. This chemical view
of fever, either as exhibited in fevers of the typhoid type, or those occur-
ring in malignant forms of disease, is not unimpoHant. If the appearance
of petechiffi during sleep be, as I suppose, an indication that the body has
passed over from the chemical state of eremacausis to that of putrefaction,
from a deficiency in tlie supply of oxygen, then the means for the pre-
vention of these states are very different, and the practice in the treatment
might be made to suit the. periodicity of the return. I throw this out as
a mere suggestion for further inquiry. But there are numerous points in
support of this view. It is only in the absence of increased action that
we observe the ammoniacal* nature of the excretions, or the pe^iuliar odour
of the breath which indicates a state of change, the very reverse of that of
eremacausis. In this state, even on the old system of treatment, bleeding
was not resorted to, but, on the contrary, stimulants were employed to cause
increased circulation ; for experience pointed out that the change thus begun
is that which continues when vitality has left the body.
This case affords a clue not only to the explanation of chronic wakeful-
ness, but also to wakefulness under ordinary circumstances. Some organic
matter, in a state of decay, has entered the body, and has thrown the blood
AND SOME OF ITS CONCOMITANT PHENOMENA. 31
into a sinular state of change. To prevent any dispute as to tlie kind of
matter, let us take the case of sympathetic fever, or that of cynanche ma-
ligna. A patient enters the hospital with a fractured bone ; — the case goes
on favourably, — ^nothing is at first observed but local irritation ; — ^then it may
assume a malignant form, — ^pus, obviously by its odour in a state of change,
is observed to collect ; — ^Uien some of this is absorbed into the blood (for
Gulliver states that he has found it there), and communicates to that fluid
the same state of change ; — then fever, called sympathetic, ensues ; but if
it be " sympathy,*' it is sympathy exerted by one matter upon another, as
a decaying orange excites decay in a fresh orange. This fever, be it ob-
served, does not arise usually when an abscess is unbroken. It is generally
excited when the pus has come in contact with air, and has united with
oxygen. We try to prevent this union by means of poultices, these poul-
tices being made of materials which will of themselves unite with oxygen,
and thus prevent it acting on the pus. Occasionally poultices are used
made of yeast and flour, as in the cataplasma fermenti of the London Pharma-
copeia, the object being to surround the pus with an atmosphere of carbonic
acid, and thus prevent the access of oxygen. The most favourite poultice in
use is that made with linseed, which from its oil and mucilage possesses a
powerful affinity for oxygen. The state of change, being once excited, goes
on, and cannot be arrested without vigorous measures ; sometimes not at all
until death ensues, from the combined effects of decay and putrefaction
following each other as the oxygen is sufficient or deficient. But the point
to be observed is this, that the change in the blood once begun is with diffi-
culty arrested ; the disposition to oxygenize is communicated, and if there
be oxygen sufficient, matter will be oxidized. Then, to apply this to our
subject, the brain becomes excited by intense thought, by the exercise of
imagination, by exciting scenes of amusement, or by whatever cause it may
be. The mind, being called into full exercise, must in its manifestations
cause a change of matter in the organ in which it resides. But in this case
the change of matter is excessive, and the tendency to oxidation is commu-
nicated to the part of the brain contiguous to that in a state of change.
This also becomes oxidized, and the cerebral substance does not get into
that state which favours the quiescent state of the mind known as sleep.
The student, after severe and exciting study, is familiar with this state of
wakefoluess. If his studies have been such as to demand the exercise of
his reason, on retiring to rest he endeavours to force his attention into
subjects the reverse of the former, generally those of imagination. In other
words, he endeavours to withdraw the mind from manifesting itself through
that portion of matter which is thrown into a state of change, and by so
doing it gradually resumes a state of tranquillity, and sleep then ensues.
But if, by excessive or diseased action, such as in insanity^ the inflamed (oxy-
genizing) matter cannot be made to yield its tendency to change, then
chronic wakefulness ensues, so often seen in the case of the insane. To re-
duce this state, we endeavour to extinguish the eremacausis, by lowering
the temperature either by cold ablution or by ice, or by administering
opium to diminish respiration and circulation. As soon as the change is
arrested in the substance of the brain (what physicians call *^ inflamma-
tion," which chemists interpret *^ union with oxygen"), the brain is placed
in a state unfit for being the organ of manifestation, and sleep ensues. The
wakefulness of patients afflicted with delirium tremens is obviously con-
nected with the amount of arterial blood and consequent inflammation and
oxygenation of the brain, and as disease is merely a disturbance of the equi-
32 DR LYON PLAYFAIR OX SLEEP,
libtium in the causes of waste and those of supply, any magnified exhibition
•of a phenomenon occurring in disease must have its reduced analogue in the
ordinary state of health. Wakefulness is that analogue, being a tendency
. to excessive change in particular parts of the bredn, induced, it is true, not
primarily by the change, but by the activity of the mind itself requiring
that chuige to aid in its manifestation. Follow the analogy, and we come
to dreaming, which, apart from its metaphysical aspect, is a physiological
phenomenon, so &r as concerns the state of the matter of the brain during
its occurrence. In fever and insanity we attempt to reduce the keen per-
ceptions or delirium by the exhibition of remedies calculated to diminish
the waste of matter in the brain. Blood is sometimes withdrawn from the
system for the purpose of diminishing the number of the carriers of oxygen.
Narcotics are administered in order to decrease the number of respirations,
and to diminish circulation. In extreme cases, large doses of brandy or
other alcoholic liquors are exhibited, for the combined purpose of depriving
the blood of oxygen and of arresting putrefaction.
By all these acts it is admitted that the excessive waste or oxygenation
of the substance of the brain renders it unfitted for the proper seat of the
mind. It is admitted that the rapid change of matter prevents the brain
attaining that state which favours the quiescence of the mind. How it does
so we do not know, and perhaps never shall. But these are established
facts, the foundation of medical and physiological practice, and therefore
cannot be denied. And if this be admitted with regard to the whole sur-
face of the brain, may it not be so of a part ! Combe tells us of a patient
who was afflicted with an imnatural increase of a feeling of the mind,
but that by applying ice to a particular part of the head which was
inflamed, the feeling subsided to its natural tone. Dreaming, then, might
be considered (this I throw out as a mere speculation) to be a dis-
turbance between the causes of waste and of supply in a particular part
of the brain. I mean that if, to use the language of phrenologists, with-
out necessarily assenting to their doctrines, the oi^n of Wonder, from
some cause or another, be thrown into a state of oxidation during sleep,
that part of the brain would be thrown out of the condition which iavours
the quiescent state of the mind ; Wonder would therefore manifest itself to
the external world without being guided by the reasoning powers or
judgment, which are in quiescence or sleep. Thus it would revel in all
the absurd phantasies to which that feeling of the mind gives rise. I have
selected this phrenological organ as a mere example of my meaning, with-
out wishing to insist upon the division of organs as a necessary part of the
speculation. If those parts of the brain used as the organs of manifestation
for judgment were brought into play at the same time as Wonder, the
dream would be more coherent, and, as soon as the change took place to
such an extent as to throw the brain into that state which did not favour
the quiescence of the mind, then waking would ensue. Hence, according
to this speculation, dreaming is a state of wakefulness of feelings of the
mind manifested through particular parts of the brain, while other feelings
. of the mind, manifested through other parts of the brain, are still asleep,
and thereforo not in a condition, by comparison and reflection, to modify
those awake. It is probable that during dreaming there is more ar-
terialized blood in the cavity of the head than during sleep without dreaming,
a circumstance indicated by the red flushed appearance of the face during
dreams. The speculation is also supported by the class of persons subject
to dreaming. A phl^;matic person, whose heart beats slowly and whose
AND SOME OF ITS CONCOMITANT PHENOMENA. 33
loDgs play slowly, rarely dreams. A fat person, with a diaphragm well
poshed up against his lungs, rarely dreams. But the greatest dreamer
is the man of nervous temperament, whose heart and lungs do not
play with all the sted&stness of the pendulum of a clock, but by causes
yet unexplained are fitful in their action. For the same reason, in fever,
the quickly circulating blood, sometimes propelled more rapidly than at
others, is apt to cause this state of wakefulness in particular parts of the
brain, by thro¥ring them into a state such as does not favour the quiescence
of the mind. However, this is a subject which is thrown out as a mere
speculation for consideration.
It may be objected to the view of sleep here given, that if it were owing
to a diminislied state of oxidation in the brain, the respiration of pure oxygen
ought to retard sleep, whereas, on the contrary, it is observed to render
the animal exposed to it comatose, and death ensues after the animal has
remained for some time in a state of deep stupor. Yet both the blood in the
veins and arteries was found by Broughton to be very florid, and every
thing indicates a high state of oxidation. Christison and other toxicologists
ascribe the death to an increased oxidation or hyperarterialization of the
hlood. The phenomena, therefore, seem in direct opposition to our theory
of sleep. But let us consider the case closely. Arterial blood differs from
venous in the state of oxidation of its iron. The peroxide of iron parts
with its oxygen to the tissues, and converts the matter acted upon into car-
bonic acid and water. The carbonic acid unites with the protoxide of iron,
and is carried as carbonate of iron by the venous blood to the lungs, where
it becomes oxidized, and the cai'bonic acid evolved ; for this gas is incapable
of uniting with peroxide of iron. Now, when an animal breathes oxygen,
even the venous blood is arterialized, or, in otlier words, there is no pro-
toxide of iron left in the system. But, owing to the excess of oxygen gas,
there must be a rapid waste of the tissues, and the formation of a large *
quantity of carbonic acid gas, which has now no iron in a state to carry it
to the lungs. It therefore accumulates in the system, and the animal be-
comes conoatose and dies, not on account of oocygeriy but of carbonic acid
which has no means of escape. It has been remarked, that there is com-
paratively little carbonic acid evolved in poisoning by oxygen, for the at-
mosphere in which the animal dies causes a blown-out taper to burst into
flame. The heart after the death of the animal is found to beat rapidly,
and shows the excited state into which the body was tlirown by oxygen,
until the accumulating carbonic acid produced the peculiar effects for which
it is remarkable. Thus, this simple explanation, while it vindicates the truth
of the theory, affords an explanation of the cause of poisoning by oxygen,
which toxicologists have always considered as most incomprehensible and
singular. The effects of nitrous oxide on the system are very similar to
those of oxygen, and are obviously due to the same cause. Broughton found
that even the venous blood* had become arterialized when an animal was
made to respire this gas.
The attentive study of the peculiar condition of matter in the various
states in which the mind manifests itself, or remains unmanifested to the
external world, is of great importance in the treatment of disease. To take
the case of apoplexy and its allied diseases. I do not allude to apoplexy occa-
sioned by the rupture of an apoplectic sac, but that form in which it arises from
the turgid state of blood-vessels in the brain, or in the more rare form of what
is termed '* simple apoplexy" by Dr Abercrombie. The state in which the
brain is placed in this disease seems to be merely an increased state of the
34 DR LYON PLAYFAIR ON SLEEP.
condition in ordinary sleep. The congestion or turgid state of the venous
vessels necessarily implies a diminished amount of blood in the arteries ;
for the skull, being a close cavity, must always contain the same amount
of fluid ; and on this account, if the quantity of venous blood be increased,
that of arterial blood must be diminished. Hence, although the use of the
lancet may awaken the patient from deep stupor, by removing the deoxi-
dized blood which may have accumulated in the brain by the lesion of a
vessel or by some irregularity in the action of the heart, yet it becomes a
question, whether the removal of blood, by diminishing the number of
c-arriers of oxygen to the brain, may not cause a tendency to relapse when
the temporary obstruction shall have been removed. All I mean by this
is, that if we admit the cause of sleep to be a diminished supply of oxygen
to the brain, we must admit certain forms of disease, such as congestive
apoplexy, syncope, perhaps even catalepsy, to be due to the increased ope-
ration of the same cause, — a circumstance attested by the diminished tem-
perature of the body which results in this class of diseases ; if, then, we
know the effects to be due to a want of oxygenation of .the substance of the
brain, we are in a position more completely to regulate our practice in the
ti*eatment of such diseases. So, also, in the treatment of wakefulness, dream-
ing, restlessness, &c., for which the physician is so often called upon to pre-
scribe a remedy, the knowledge of the state of the brain in the state of
waking and of sleep, may point out the way to throw it into the state which
fevours the activity or quiescence of the mind. Hence an accurate defini-
tion of these states is not unimportant in a practical point of view.
It does not necessarily impair the accuracy of such a definition, that many
assumptions are taken for granted to explain one part of the phenomenon.
When we see a wheel revolved by the ascent and descent of a piston-rod,
our explanation of the means by w hich a perpendicular is converted into a
rotatory motion is not rendered valueless because we do not trace it to the
means by which the force is generated. We have a right to assume the
existence of the necessary force, and from this point alone attempt an ex-
planation. So, also, when I say that the effect of a diminution in the play
of the respiratory organs induces sleep, as in the case of intense cold, or that
their accelerated action retards sleep, as when the temperature is only
slightly depressed ; mj conclusion may be perfectly correct, without my
being called upon to prove the cause of the diminution in the action in the
one case, or its increase in the other, because my attention is confined only
to one part of the phenomenon. So, also, if I say that syncope id due to a
diminished quantity of arterial blood in the brain, I may be correct as to
the proximate causey without being obliged to show by what means the
conducting power of the nerves leading to the involuntary organs has become
so impaired as to cause the temporary obstruction of these organs. In de-
scribing the chemical state of the body, and the effects produced by this
state, the duty of the chemist is only to consider the proximate cause of its
production, while the physiologist ought to explain the ultimate causes
which predispose the body to enter into that state. I have attempted to
explain in certain cases one part of the phenomenon, not for the purpose of
giving idle play to fancy, but with the hope that these speculations, if they
do not of themselves represent the truth, may lead other persons to the
coiisideration of the same subject.
ORGANIC DISEASES OF THE UTERUS. 35
paet il— reviews.
A Practical Treatise on. Organic Diseases of the Uterus. By
John C. H. Lever, M. D., &c. 8vo, pp. 228. London, 1843,
Longman & Co.
The industry with which Midwifery, in all its departments, has
of late years been cultivated in this country, has placed this most
uscM branch of our profession on a footing fully equal with, and
indeed superior in soundness of principle to, the position which it
occupies on the Continent. Our periodical literature teems with
useful physiological, pathological, or practical observations, and
there is no lack of valuable essays on particular subjects, and*
systems of great excellence.
We do not hesitate to state, that the volume before us, though
it does not contain much that is very novel, substantiates, how-
ever, by statistics, and an ample collection of well-selected facts,
our previous knowledge of obscure diseases, of which, in this
impretending treatise, we have in many instances a graphic,
account, devoid of those numerous but useless generalities and
tiresome speculations by which we are too frequently nauseated
while perusing similar works by our continental brethren. Dr
Lever is placed in an enviable position for acquiring a sound
pathological knowledge of female diseases ; and we must do him
the justice to say, that he seems to be armed with zeal and indus-
try — qualifications which are indispensable for a man who enters
the field which he has undertaken to explore.
The subjects embraced by this volume are classed under three
heads, viz. Part First, Acute and Chronic Inflammation of the
Uterus ; Part Second, Specific Diseases ; and Part Third, Ma-
lignant Diseases. We extract the following account by the author
of the relative proportion of functional to organic disease.
^ Of 2582 who applied for relief, there were 1660 cases of functional to
922 of oiganic disease. In 905 cases of functional derangementy there were
with Leucorrhoea 310, Menorrhagia 125, Chlorosis 145, Hysteria 68, Dys-
menorrhoea 27, Irritable Uterus 19, Vicarious Menstruation 7, Epilepsy 6,
Chorea 2, Hemiplegia 2, Amaurosis 1. In 483 females with organic dis-
eases, there were affected with Inflammation of the Os and Cervix 17I9
Carcinoma Uteri 104, Hard Tumour of the Uterus 69, Fungoid Disease
36 ORGANIC DISEASES OF THff UTERUS.
45, Chronic Inflammation of the Uterus 44, Induration of the Os and Cer-
vix 28, Polypus 12, Chancre of the Os Uteri 4, Miliary Disease of the Os
and Cervix 3, Hysteritis 2, Cauliflower Excrescence 1.** P. 2.
To his own, Dr Lever adds the experience of resident practi-
tioners abroad, regarding the comparative frequency of the dis-
eases under consideration, which, independently of the valuable
matter furnished by himself, will recommend his performance to
his professional brethren as a useful book of reference. Thus,
** At CorfUy one in 50 suffers from dysmenorrhoea ; carcinoma uteri hap-
pens in the same proportion ; while all who are affected with the latter
have had syphilis in early life* At Jamaica^ 20 out of every 100 adult white
females are subject to functional derangement ; 10 per cent, to carcinoma, all
of whom had painful or suppressed menstruation previously : diseases of the
uterus, whether functional or organic, are very rare amongst the blacks. At
Quebec, among the French Canadian women, carcinoma uteri is said to occur
in the proportion of 3 in 50, and in females who had previously been affected
with amenorrhoea or dysmenorrhcea. The same observations are said to be
^ applicable to Indians, more especially those located in the vicinity of large
towns. Among the British Canadians the propoi*tion is stated to be the
same, and that the subjects had always previously suffered from dysmen-
orrhoea. In convents the occurrence of functional and organic disease is
more frequent ; 10 women in every 50 are said to suffer from organic lesion.
At Halifax^ one woman in 40 is said to be affected with organic disease, and
generally those who had been subject to scanty menstruation. During
several yeare* experience at Belle Isle, Upper Canada, only one case of car-
cinoma uteri had been met with, and this too in a woman who had suffered
from deficient and painful menstruation. In Montreal^ 8 in 50 are said to be
affected with functional derangement ; 2 in 50 with oi^nic disease," P. 3.
From the foregoing observations it is evident that dysmenor-
rhcea frequently predisposes to organic disease of the uterus,
while it must also be well known to those engaged in practice
that the same causes which often in early life give rise to painful
menstruation, as the depressing passions, are likewise, at a more
advanced age, frequently concerned in producing carcinoma uteri.
Our author next proceeds to inquire whether married or single
women are most disposed to organic changes, and a very little
consideration of the subject would naturally lead us to infer that
the former are far more so than the latter, owing to their greater
liability to excitement, and to injuries arising during sexual con-
gress and the important function of parturition ; and hence it is
very satisfactorily shown that matrons are more disposed to or-
ganic disease by a very large majority. Thus " of 98 affected
with polypus, carcinoma, fungoid disease, and hard tumours, 89
were married and six single." P. 5.
The third question considered by the author (p. 5) is, " Whether
ORGANIC DISEASES OF THE UTERUS. 37
the diathesis accompanying organic disease impairs the faculty of
conception?" The result of Dr Lever's experience tends to
prove that such a disposition exerts very little influence in limit-
ing the frequency of conception; and accordingly, of the 89
women already referred to, 8 only were barren. This is quite
in accordance with our own experience. We cannot remember
a single instance of chronic organic disease of the uterus in a
barren female ; while all the applications that have been made to
us were by matrons, some of them indeed with rather a numerous
progeny. And on considering that the ovaries, not the uterus,
hold the first rank in the reproductive system of the female, we
should not expect that the latter organ, except when the seat of
extensive morbid lesion, would exert much influence in impairing
the reproductive function.
The fourth and last question considered by our author is,
" Whether organic disease interferes with the vitality of the
offspring?" Our own impression, derived from many years'
experience, though not on so extensive a scale as that which Dr
Lever has had the good fortune to enjoy, is, that the vitality of
the foetus, except when there is severe constitutional disturbance,
and not always even under these circumstances, is not compro-
mised. We have been consulted in cases of enlargement and
remarkable incrassation of the cervix uteri, and where, but a
few weeks previously, such individuals had produced living chil-
dren at maturity : we have known women with cauhflower ex-
crescences of the OS uteri produce living children at maturity,
though for many weeks previously they endured paroxysms of
excessive pain, and copious hemorrhagic and leucorrhoeal effu-
sions : and we have somewhat recently assisted at a labour which
was protracted in consequence of the os and cervix being the seat
of numerous cauliflower excrescences, and other fearful disorgani-
zations; but a living, mature, and an apparently healthy off-
spring was produced. Our author's experience on this head is
very satisfactory. " 81 women conceived 553 times, 43 con-
ceptions terminated in abortion, and 510 children were born at
the full time ; and of these 510 children, only 12 were stillborn,
owing in all probability, as it is inferred, to the non-dilatability
of the parts, and consequent pressure on the foetus." P. 6.
A considerable portion of the work is now taken up with some
pertinent directions regarding the various modes of examination,
the varieties of specula, and the manner of using these instru-
ments. With these particulars we do not deem it necessary to
38 ORGANIC DISEASES OF THE UTERUS.
occupy the time of our readers, since the different methods of
investigating uterine disease are familiar to every one, and since
even the village apothecary must be intimate with the method
of introducing the speculum, as it is now become so fashionable
among the higher orders of the fair sex of this country, that were
a practitioner not to employ it for the exploration of pelvic dis-
ease, the patient would think herself quite neglected. We shall
conclude our observations on this section of the work by a single
remark on an expression used by our author (p. 8), viz. " dis-
location of the uterus." To ourselves this phrase is new, and by
no means so appropriate as the one we have been wont to em-
ploy ; and were it not that the writer has shown so much good
sense in the construction of his treatise, we should have been
more than half inclined to think that either his tongue or his
fancy had been dislocated when he used this expression.
The next section of the work is devoted to the consideration
of acute, sub-acute, and chronic inflammation of the uterus. Here
we did not expect, nor do we 'indeed find, any thing new, except
that we are informed (p. 39), " That not unfrequently women
who have suffered from hysteritis do not again become pregnant,
in most cases from closure of the Fallopian tubes;'' and that
the use of ergot is followed by sub-acute inflammation (p. 43). On
this last point the author will be permitted to speak for himself : —
^ In some cases the inflamination is of a sub-acute kind from the firsts
and especially in those where ergot has been given improperly. I had
under my care five females attended by the same individual, to all of whom
he had given the secale, and who were affected by the same symptoms."
In regard to sterility being a sequence of hysteritis, Blatin and
Nivet (p. 342) entertain the same opinion ; but so far as we are
aware, they are the only modern writers, besides the author, who
do so. Chambon, Boivin and Duges, and Duparcque, are silent
on the subject ; and as to ourselves, although our experience in
hysteritis, under the different forms particularized, has been
pretty extensive, we have never had occasion to make any cor-
responding observation. Were the Fallopian tubes at any time
the seat of inflammation, or frequently subject to excitement, as
they are liable to be in prostitutes, and their fimbriated extre-
mities to cohere, in consequence, to some adjoining structure,
barrenness would most probably be the result ; and, accordingly,
cases are recorded where this has happened.*
• Morgagni Epist xxvi. art. 14, xlviii. art. 32; Med. Chir. Trans. Lond.^
vol. viii. p. 603, vol xiii. p. 66.
ORGANIC DISEASES OF THE UTERUS. 39
The fact stated by Dr Lever respecting the secale is valuable
in the extreme ; and we consider the profession under deep ob-
ligation to him for his discernment. For ourselves, we can say
little of this dangerous agent from personal observation ; but we
venture to assert, from what little we have seen, and from con-
versations with many of our brethren, that there is not a man of
candour engaged in midwifery practice who could deny, if he
were solemnly asked the question, that he had known the foetus
destroyed where ergot had been exhibited. We regret much that
Dr Lever has not stated what he means by its improper use, and
under what regulations it had been exhibited in the cases to
which he refers ; but we earnestly trust he will do so on an early
occasion ; indeed he is bound to communicate his sentiments on
this important subject. We can say that ergot has been followed
by the most mischievous effects on the foetus, such as fractures
of its cranial bones ; or when it escaped these injuries and was
born alive, we have known meningitis supervene.* We have
occasion to know, that as it was at one time with mercury in
syphilis, so it is now with the secale — far too indiscriminately
employed. Some of our brethren never think of going to a case
of midwifery without being in possession of ergot ; but, however
excusable it may be for gentlemen in the coimtry to go " armed
at all points," in town, however, their doing so is most repre-
hensible, since the agent in question might possibly be used to
save time and trouble in a case in which, on mature reflection, it
would never have been employed.
In the treatment of chronic hysteritis, we find the following
most judicious advice, and which we would strongly recommend
to the attention of such of our brethren as are wont indiscrimi*
nately to inundate the sexual canal with lunar caustic solutions,
and other powerful astringents.
"In the advanced stages, the decoct, papav. cum alumine, in the propor-
tion of 3ij. of the latter to a pint of the former, is a very valuable remedy :
but in employing vaginal injections, we must be especially careful to refrain
from the use of astringents while there are symptoms of activity about the
disease." P. 55.
We coincide entirely with Dr Lever regarding the use of as^
tringents, which, when used at too early a stage, we have known to
occasion distressing consequences by aggravating the disease, and
rendering the case equally untractable with scirrhus itself.
• For gome valuable observations on the injurious effects of ergot, and the regu-
lations which should be observed in exhibiting it, see Campbells' Midwifery, 2d
Edition, pp. 184 and 244.
40 ORGANIC DISEASES OF THE UTERUS.
We have next some very judicious directions for the treat-
ment of the sequelae of chronic hysteritis. For hypertrophy of
the uterus the author eulogizes very highly the use of leeches,
mercury, and iodine. Of the former he directs six to be appUed
to the uterus twice a-week ; he gives the preference to the hyd.
c. creta given twice daily, until the system is gently affected ;
and he employs the protoiodide of mercury with great advan-
tage.
We cannot do better than transcribe for the perusal of our
readers one or two illustrations of the treatment pursued, from
the work itself : —
** E. P., set. 25, of fair complexion, and pale exsanguine countenance,
married at 16, has given birth to five children, all of whom except the
last were born alive. In her last labour the shoulder presented, the
process continued 48 hours, and turning was practised. From the
time of her delivery she has suffered from uneasiness, bearing down,
constant weight, tenesmus, difficulty in micturition, and a copious leucor^
rhoeal discharge. The catamenia recur every fortnight, continue four or
five days, and occasionally contain coagula. On examination per vaginam,
the uterus was found to be increased in size and weight, and to press low
in the pelvis ; a firm cicatrix was to be felt upon the middle of the pos-
terior lip. When the hand was placed above the pubes, the enlarged
organ could be readily detected. She was ordered hirud. xij, reg. pub. et
inguin. bis hebdom. Fotus conii ter die injiciend. Pil. conii c. hyd. o. n.
mist. mag. c. mag. sulph. ^ ter quotidie. This treatment was persevei*ed
with for three weeks, when the medicine was changed for the following :^
Hyd. protoiodid. gr. ss. confect rosae canin. q. s. ft. pil. omni nocte
sumend. hor& decubitus. R. pot. iodid. gr. iij. extr. sarsae. gr. x. ter die
ex mist, camph. In this plan she persevered six weeks, and during that
time she was twice leeched, as she suffered from severe pain. Tlie uterus
became at first softer, then smaller, the intervals between the appearance
of the catamenia more distant, while the secretion continued but three
days, and was of a natural colour.'' P. 58.
*^ M. T., St. 44, has borne nine children, and miscarried once. Menstru-
ation commenced at 15, and during these periods she was frequently
confined to bed from excessive pain. The secretion was skinny, and oc-
casionally contained coagula. She had pains in the back, loins, and thighs,
and the catamenia continued three weeks, with a white leucorrhoeal' dis-
charge during the intervals betwixt the menses. In the last twelve
months the catamenia have returned at intervals of from two to three
weeks. On examining the uterus it was found enlarged, its vessels
strongly throbbing, its weight much increased, aperture swollen, turgid,
highly vascular, and of a livid colour, but free from abrasion. She was
ordered 6 leeches to the vagina twice a- week, a mild astringent injection,
the dec. tormentills c. alumine, and the following medicines: R. pil.
hyd. gr. ij. ext. conii gr. iij. m. ft. pil. omni nocte sumend. R. mag.
sulph. 3 as. tine, cinchon. c. 3j. syrup aurantii 3ss. infiis. gent. c. 3x.
ft. haust. ter quotidie sumend. After continuing this treatment tc»n
days her gums became rather tender, but the uterus smaller, less swollen
ORGANIC DISEASES OF THE UTERUS. 41
and taigid. She perseyered in this plan of treatment six weeks, and was
then perfectly convalescent." P. 61.
We come now to consider very briefly induration of the
uterus as a sequela of chronic inflammation. Our author says that,
^ Before resolving upon the treatment, we should first satisfy oniselves
that the indnration is the result of chronic inflammation, and not the com-
mencement of malignant disease. Induration, the result of chronic inflam-
mation, may be known by its regular feel and by the history of the case.
In most instances there has been the creamy discharge. Induration, the
commencement of malignant disease, is in nodules, the malignant depo-
sitions being generally secreted in central points." P. 64.
We must beg leave to tell Dr Lever that he has treated this
important point with far too much brevity, and we think not
with strict correctness. If the diagnosis were as simple as the
foregoing passage would lead us to believe, our duty in this respect
would be easy indeed; but it is far otherwise, and two fre-
quently the diagnosis cannot be established with any degree of
confidence even by veteran practitioners ; and we are therefore
a good deal surprised that the author has not enlarged on this
subject. For ourselves, we have long been of opinion, not only
that it is extremely difficult, if not impossible, in many in-
stances to draw a line of demarcation between induration the
result of chronic inflammation, and induration as the incipient
stage of cancer, but that indeed the former degenerates into the
latter ; and in these opinions we are satisfactorily supported by
Boivin and Duges (vol. ii. p. 277), and Duparcque (vol. i. p.
242), who are the most recent and among the best authorities
on uterine diseases. To the writings of Sir C. M. Clarke we
shall not refer, because though valuable at the time they were
published, the pathology of organic diseases of the uterus was
then, comparatively speaking, in its infsuicy. For indurations
iodine and mercury are highly eulogized, with the local abstrac-
tion of blood by scarifying the os uteri, and the use of aromatic
tonics, as columba and cascarilla. In the early stages of this
variety of degeneration we are quite aware that much may
be done to benefit the condition of the patient ; but while we
would encourage perseverance in the use of the means parti-
cularized, we consider it but just to caution our younger brethren
agaunst being too sanguine of success ; for those cases, as every
candid and experienced practitioner must avow, too frequently
baffle the best-directed efforts.
The fourth sequela of chronic hysteritis noticed by our
author (p. 68) is simple rdcerationy which he informs us, and
42 ORGANIC DISEASES OF THE UTERUS.
very properly, can only be elicited by ocular inspection aided
by the speculum, for the ulcer sometimes does not exceed a pin-
head in size. " In many cases the ulcer resembles a cut
surface ; in some it is thin, shallow, and deeper than the mucous
membrane, while not unfrequently it bleeds upon the slightest
touch." These cases are preceded by symptoms of inflammation,
as rigors, reaction, fever, obtuse pain, a sense of dragging in
the loins, weight in the anus, increased uneasiness during
menstruation, pruritus of the vulva, and leucorrhoea varying in
colour and consistence, usually streaked with blood. The
posterior lip of the os uteri is thought to be more frequently
the seat of ulceration than the anterior, but either may be
affected. Among other causes, the author particularizes the
use of irritating astringent injections, a practice the most re-
prehensible where there are such symptoms as indicate irrita-
tion of any pelvic viscus, and against which we cannot too
often reiterate our disapprobation.
We give the following passage as the author's sentiments
regarding the diagnosis betwixt simple, syphiUtic, and corroding
ulcers, without at all assenting to the opinion that these different
lesions are to be distinguished from each other so easily as the
brevity of Dr Lever's remarks, and the air ofc confidence with
which they are written, might lead a reader unacquainted with
these subjects to infer. We need only remind practitioners of
the difficulty of deciding in cases of syphilis, even, though so fre-
quently accustomed to examine them, whether the sore be of
this nature or not, unless from the moral character of the patient
there be strong presumptive evidence.
Diagnosis, — " They may be distinguished from syphilitic ulcerations by
the regular hard edges of the latter, by the yellow sanious discharge ; and
in some cases assistance is gained from the moral character of the female.
Its limited extent and superficiality, its slighter constitutional effects, the
absence of large bleedings, and the discharge, distinguish it from corroding
ulcer ; while from the malignant cancerous ulceration it may be recognised
by the want of hardness from morbid deposit, by the nature of the pain,
and the character of the discharge." P. 69.
Dr Lever's treatment of these cases is very judicious, and
were it not for our circumscribed Umits, we should feel justified
in quoting the whole of it, but we trust to the professional com-
munity consulting it for themselves, as it will amply repay them.
In the acute stage the local abstraction of blood is inculcated,
with other agents calculated to allay irritation ; and in chronic
cases the direct application of lunar caustic and the improvement
ORGANIC DISEASES OF THE UTERUS. 43
of the general health are recommended, and we entirely concur
in the recommendation.
The next section is devoted to the consideration of ulcers on
different parts of the uterus in cases of procidentia, which re-
quire nearly the same remedial means as similar lesions affecting
the organ while in situ. To the foregoing succeeds a succinct
notice of enlargement of the glands of the os and cervix tUeri
as a sequela of hysteritis, which is characterized by pruritus
amounting in some instances to nymphomania, slight leucorrhceal
discharge, and occasionally redness of the vagina, which may be
the result of frictions by the patient herself. By the aid of the
speculum — ^and no other mode of exploration should be confided
in — small granules, not unlike millet-seeds, white, soft, seemingly
vesicular, and numerous, are observed. For these cases, cupping
or leeching, according to the amount of irritation, or in the
absence of tenderness^ solutions sulph. ferri or nitrat. argenti
are recommended. All these sequelae of hysteritis are illustrated
by cases which greatly enhance the value of the work.
Part IL of this publication (p. 79) embraces what the author
denominates Specific Diseases^ viz,, first. Tumours of the Uterus,
which are allowed by all writers not to possess any malignity,
as polypus; and, secondly. Fibrous Tumours. Though un-
questionably a most valuable section of the treatise, we are never-
theless obliged to pass it without comment, and with the exception
of a solitary case, without quotation, since the subjects embraced
have recently received great attention, and must be familiar to
all our bretlu'en who feel an interest in the diseases of females ;
but Dr Lever must not on this account suppose that we consider
his second in importance to the additions which have of late been
made to our knowledge in this department of practice. From
this portion of the work we quote the following instance of a very
rare disease, viz. Strumous Tubercles of the Uterus. We shall be
excused for this lengthened quotation when we state that Louis
met with only one instance in 358 cases which he had examined.
Case XXX. — "I was requested to visit a lady of 26, who had been
married only ten days, and had previously enjoyed good health. After
her marriage she went on a long journey, and while some distance from
home, in descending the stairs of an hotel, she felt a pain at the lower part
of the abdomen. The uneasiness did not subside, and was accompanied by
sickness, impaired appetite, &c. The bowels were regular, but the pulse
was excited. She missed her next monthly period, and the sickness, if any
thing, increased ; as also the uneasiness in the abdomen, and her countenance
hecame anxious. In about three weeks there was a decided fulness in the
44 ORGANIC DISEASES OF THE UTERUS.
lower part of the stomach, and upon carefdl examination a tnmonr could -
be felt. The pain over the swelling was greatly increased by presBure ;
the sickness augmented ; the emaciation increased ; her appetite became
less ; and notwithstanding tonics, iodine, &c., were prescribed, this young
lady became decidedly worse. I consulted with two eminent physicians,
and they concurred with me in opinion that this young lady was not
pregnant, that the disease under which she was labouring was tubercular
peritonitis, and that the tumour in the region of the uterus was probably a
large tubercle, or a cluster of tubercles. Vaginal examination detected the
uterus to be completely fixed in the pelvis. Within five months from the
date of marriage, this lady (without the menses having made their appear-
ance) became greatly emaciated. The immediate cause of her death was the
giving way of the diseased intestines, and consequent escape of their con-
tents into the abdomen, causing peritonitis. Upon examination the whole
of the peritoneum was found to be studded with tubercles ; attached to
the uterus there was one of very laige size ; while, in addition, the whole
of ' the structure of this viscus was completely infiltrated ; in fact, the
tubercular deposit appeared to be universal throughout the body. This
case was. remarkable from the patient being very robust and stout., with
rosy cheeks, &c., before marriage ; and from her being seized, ten days after
marriage, with acute pains which continued until her decease." P. 132.
Part Third of the work, extending to about ninety pages,
embraces what are styled malignant diseases of the uterus ; such
as cauliflower excrescence, corroding ulcer, melanosis, and cancer.
As it would be pure waste of time to enter into any elaborate
comment on these subjects, since, generally speaking, they baffle
our ingenuity and judgment, and that scarcely any thing can be
said regarding them beyond what is already well known, our
readers will excuse us if we merely take a rapid glance at each
of them in succession. Our author gives a very good description
of cauliflower excrescence, which he says
" Consists in the growth of a highly vascular tumour, of a bright flesh-
colour, with a granulated surface, generally growing from a part or the
whole of the os uteri, and sometimes also from the uterme cavity. This, in
comparison with the other organic diseases of the uterus, is rare, our author
having met with it only G^ree times in a list of more than 350 cases of
cancer of the womb. The structure of this excrescence is pretty firm ; but
still, if pressed strongly by the finger, it bleeds. It has a very fine mem-
brane spread over it, which secretes a copious watery fluid. After death
the tumour disappears, nothing being left but a mass of flocculi, apparently
empty vessels : the same effect takes place when the excrescence is noosed.
If a ligature be applied, and the tumour removed beneath it, it will
rapidly grow again. It has been met with in females of all ages, tempera-
ments, and habits, and in the single as well as the married ; injuries during
labour have been supposed to occasion it, but this would not account
for it in females who never had a family ; by others syphilis and excessive
coition have been thought to lay a foundation for it, but prostitutes do
not seem to be more subject to it than virtuous and prudent females. It
commences with a moisture in the external parts, amounting very soon to
ORGANIC DISEASES OF THE UTERUS. 45
a oopions wa^ry dischaiige from the Tagin% in quantities geneiall j so
profuse that several napkms are moistened daily. The countenance be-
comes blanched and sallow, eyes sunk, vision impaired, pupils enhu^^,
respiration hurried during exertion ; there is palpitation, pain in the left
side, despondency, dyspepsia, thirst, emaciation, tympanitis, and oedema of
the pelvic limbs. At first the discharge per vaginam is merely streaked with
blood, but it soon becomes quite hemorrhagic. The ordinary examination
merely will excite bleeding." P. 138.
The foregoing corresponds very nearly with our own expe-
rience in four cases which came under our observation : in the
firsts the patient was seven months pregnant, and there were
three tumours, each the size of a child*s clenched hand, attached
to the OS uteri ; the second was a lady about 55 years of age,
with only one excrescence of this character, like a cWld's flattened
hand, growing from the posterior lip of the uterus ; the third
was a lady of 52, with a tumour of this nature the size of a small
pear, growing from the interior of the uterus, but unlike all the
other cases we met with, it was so soft that the least interference
broke off portions of it ; and the fourth case we met with recently
in a woman in labour, attached to whose os uteri there were five
or six of these tumours, from the size of a filbert to that of a
wabut. As no other than the most unfavourable prognosis can
be offered in the foregoing cases, we shall merely make a bare
enumeration of the means which have been used for relief, and
which can only be considered as palliatives : these are, excision,
caustic, with the more powerful vegetable and metallic astringents,
tonics, a bland nutritive diet, and abstinence from stimuli and sex-
ual congress.
We are next (p. 145) furnished with a description of corroding
ulcer, of which, as it resembles cancer in many particulars, and
is equally intractable, we shall merely state its principal features.
This term was first used by Dr John Clarke, to a disease which
consists in a malignant ulceration of the os and cervix uteri, the
remainder of the organ being scarcely even enlarged. One sin-
gular feature of the disease is, that there is no deposition of new
morbid matter in any part which it affects. It may extend to
the bladder, rectum, or to the upper regions of the uterus. The
glands about the cervix are the structures first affected, and most
frequently in females verging towards forty, or the period when
the catamenia take their final leave. When the parts are ex-
amined after death, sufficient evidence is displayed of serious de-
vastation of structure, but without induration, hypertrophy, or
new deposit.
46 ORGANIC DISEASES OF THE UTERUS.
^ Females of a lymphatic temperament are said to be more liable to the
disease than other subjects. It is preceded by an occasional sense of un-
easiness in the pelvis, heat, and leucorrhoea, all of which are unfortunately
too often disregarded until hemorrhage appears. As the malady advances
there is emaciation, dyspepsia, gastric irritation, sallow countenance, excited
pulse, a sense of general weakness, of weight and pain in the back, extending
to the loins and around the lower part of the abdomen. The pain varies,
producing an obtuse, lancinating, or burning sensation. The hemorrhage
jrecurs, sometimes with an alleviation of the uneasy feelings ; and during the
intervals there is an ichorous discharge from the vagina, so acrid as to exco-
riate the external parts. For some time at first the patient's complaints
are considered hysterical, and her ailments receive no attention until
hemorrhage appears, when an examination per vaginam is granted, which
discovers an amount of mischief previously unsuspected. If we trust
to the ordinary examination, the ulcer, unless large, may not be discovered,
for the patient scarcely complains of pain when the finger is brought into
contact with it." P. 146.
Some years ago we had occasion to be consulted in a case of
this nature, which two other physicians — one of them most ex-
perienced — ^hadsome time previously seen ; but the patient being
considered by them to be merely hysterical, and her friends
advised not to encourage her whims, no local treatment was
adopted. The day after visiting this individual, the speculum
was used for the first time, and a large ulcer discovered in the
posterior Up of the os uteri. She ascribed her complaints to ill
usage from her husband, and died three months after we had been
called. In every suspicious case, as exploration by the fingers
is insufficient, the speculum must be employed ; and by it we
shall probably eUcit — ^not a deep ulcer — ^but one much extended,
with a rough granulated surface. A marked feature of this com-
plaint, and which distinguishes it from carcinoma, is, that the
uterus possesses fully as much mobility as in a state of health, and
that it is not enlarged. Ulceration advances until a breach is
formed in the bladder, or in the rectum, or in both, which reduces
the patient to a loathsome condition, and soon terminates her
sufferings.
Dr Lever tells us that these are hopeless cases, and for an
obvious reason ; because, from the natural deUcacy of the sex, an
examination is too frequently resisted until the disease has made
such progress that neither excision nor any other remedy can
avail. Were an opportunity afforded of making an efficient in-
spection of the uterus when its os or cervix is merely in a high
state of irritation, or even ulcerated in a trivial degree, the prac-
titioner should not despair of procuring permanent relief by
cupping on the sacrum, and the local application of leeches ;
ORGANIC DISEASES OF THE UTERUS. 47
caustic after excitement has been subdued, and other appropriate
measures. Dr Lever says (p. 151), that " if, when first con-
sulted, we are certain of the nature of the ulceration, and if there
be a septum of healthy tissue between the disease and body of
the uterus, in my opinion we should act wisely by excising the
OS uteri." We are happy to state that there is (p. 209) but one
other siich absurd passage in the volume before us ; if there had
been many, we certainly should not have devoted so much time
to its analysis. The commencement of the disease is the only
time for even contemplating excision ; and we defy the most ex-
perienced to decide what is the nature of the complaint at that
stage ; and, secondly, we deny that the os and cervix, while the
uterus is in situ, can ever be examined with such precision, how-
ever practised and acute the eye may be, as to determine if there
be a septum of healthy stcucture between the diseased point and
the body of the womb. We hope, therefore, that no one will
act on the dictum of Dr Lever by practising excision, but, on
the contrary, trust, in the incipient stage, to local bleedings —
an antiphlogistic regimen — ^hip warm bath, with strict tranquillity
of mind and body, which we are confident will be found far safer
and more certain than the knife, the utility of which must at
best be problematical, and may only accelerate the fatal cata-
strophe.
We have next (p. 151) a case of very rare disease, viz.
Melanosis of the uterus, in a woman of 45, who was at
first supposed to be the subject of hard fibrous tumour. She
had been more than twelve months complaining when she
applied to the author. Four months from the date of her appU-
cation, a profuse flow of blood escaped per vaginam, and con-
tinued for a long time, followed in the course of a few days by a
dark, brownish black discharge, having a peculiar odour. In
six weeks from the commencement of the hemorrhage, she was
carried off by a diarrhoea. On dissection, the uterus was found
enlarged, and a tumour at the right and anterior part of it, the
size of a fist, developed in the proper structure of the organ.
This adventitious formation varied in consistence, being firm
externally, and much softer towards the uterine cavity; the
mucous membrane covering it was destroyed, and the tumour
itself converted into a melanotic mass.
Cancer uteri is divided by our author into three stages, the
premonitory symptoms constituting the first. This division we
consider a useless refinement, and partaking somewhat of that
48 ORGANIC DISEASES OF THE UTERUS.
disposition for generalizing so characteristic of our Gallic neigh-
bours ; but to gratify the writer, we shall follow him very briefly
in what he considers the first stage.
'^An examination per vaginam discovers the edge of the os uteri in-
durated, sometimes fissured, irregular in form, projecting unusually into
the vagina, studded, in the situation of the muciparous glands, with projec-
tions which feel like gravel or grains of shot, that become paiuful on
pressure, which also occasions sickness. The use of the speculum displays
turgidity of the os uteri, which will be seen of a deep crimson colour, while
the projecting shot-like points present a bluish hue. As yet the disease is
confined to the os and lower part of the cervix, and the uterus is generally
moveable. This state is very tardy in its progress, for we have knoMm it
continue with little alteration for years.
*' In the second stage the uterus subsides considerably in the pelvis, by
its weight and change of position interrupts the functions of defecation
and micturition, and occasions uneasiness while the patient is either in the
erect position or walking. The lancinating pains, which were at first but
trivial and rare, are now frequent and severe, and the discharge from the
mucous lining is increased, occasionally stredsied with blood ; but as yet
it is destitute of foetor and acridity* The uterus is now tumefied and
indurated, its aperture notched and dilated, and the organ is less moveable
than in the first stage. Previous to ulceration taking place, we may by
ocular inspection be able to discover some one point of Uie indurated part
softer than the rest ; and in this spot, which feels very painful, idceration
will commence. During this inspection also, the cervix presents a swolleui
tense, and shining appearance, a spongy feel, and a deep brown colour.
^ In the third stage the pains are much aggravated, described as lancinat-
ing, burning, or gnawing, recur in paroxysms, more severe at night than
during the day-time, occasionally accompanied by sanguineous dischai^es,
which are the first indications of a breach of continuity, and in their
absence leucorrhcea of the most offensive odour. This latter discharge
changes in colour from brown to dirty white, green, or black, slightly
effervesces with sulphuric acid, and turns syrup of violets to green. As
the disease progresses, the bladder and rectum are perforated, the latter
more frequently than the former. An examination of the interior of the
pelvis detects a hard, irregular, immovable mass, filling its cavity, the os
uteri considerably more dilated than usual, indurated, painful to the touch,
and bleeding on the slightest interference."
Dr Lever does not believe that the disease can be transferred
from one subject to another, neither do we. He says,
*' I have for some years paid particular attention to this question, in
order to ascertain whether the husbands of women affected with ulcerated
carcinoma have contracted the disease^ and in no instance have I l>een able to
detect the supervention of cancer in the male,**
But although the complaint cannot be. transmitted, we quite
concur with our author in thinking it hereditary. He says,
**Ihave seen several instances of mothers and daughters dying from this
malady; and in one instance, I traced the disease through three generations,
the grandmother, mother, and daughter, all falling victims to it. The regi»-
ORGANIC DISEASES OF THE UTERUS. 49
ters of the obstetric out-patients of Guy's Hospital show that the propor-
tion of cases of carcinoma uteri to other cases of uterine disease is nearly
as 1 in 7."
Females of a lymphatic temperament are thought to be most
disposed to it ; and from what was stated in the commencement
of this analysis,' those who hare been martyrs to dysmenorrhcea
must certainly be included in the Hst. We consider mental
anxiety, the depressing passions, repeated abortions, and a la«
borious occupation, fertile exciting causes ; and though denied by
our author, we have had many painful proofs that gonorrhcea
may be viewed in the same light. Dr Lever satisfactorily
repudiates the opinion that virgins are more subject to the dis-
ease than married women ; from his observations {Med. Chir.
Trans. Land., vol. xxii. p. 269) it would appear that from the
" 40th to the 60th year is the most frequent period of attack.
Of those afiFected, single women bear a proportion of 5.83 per
cent., married women, 86.6, and widows, 7.5." We also extract
the following interesting statements: " The number of women
with fair complexion affected with cancer uteri amounted to 20.8
per cent., of those with dark complexion, 79.16 per cent. ; 25 or
20.8 per cent, enjoyed good uterine health in early life, while
95 or 79.16 per cent, had suffered from functional disease or
syphilis ; death occurred in 107 cases, the average duration of
the cases being 20^ months ; the shortest duration of the disease
was 3 months, and the longest 66 months."
In remarking on the Prognosis, our author believes, and we
unhesitatingly agree with him, that after the disease has passed
mto the stage of scirrhus, it is quite hopeless.
On the subject of Diagnosis, we are told to rely on the shot-
like bodies deposited in the seat of the ova tiabothi, the presence
of induration, and the less sensitive condition of the diseased
structures in carcinoma uteri, to enable us to distinguish this
from irritable uterus. From simple induration, scirrhus is known
by the greater hardness of the part affected, its being more
lobulated, by the increased deposition into the surrounding struc-
tures, and the uterus being less moveable.
In the treatment, the author places great reliance, during the
first stage, on cupping upon the sacrum, the direct application of
leeches to the uterus, anodyne injections, mercury to produce a
gentle effect, in combination with opium, hyoscyamus, conium,
or camphor ; while the liq. potass, arsenit. is highly eulogized
for subduing uterine uneasiness. Counter-irritants are also
G
60 THE PHYSIOLOGY OF INFLAMMATION.
recommended, as a succession of blisters, or an issae oyer the
sacrum, or either sacro-iliac symphysis. All stimuli — ^regiminal,
mental, and sexual, should be strictly avoided ; while tranquiUity
and ease are to be sedulously obseryed. Our author does not
seem favourable to the excision of the os uteri, neither does any
practitioner of this country, except such as are guiltless of com-
mon sense. We are saved the trouble of considering the merits
of the merciless and sanguinary operation of removing the uterus
while in situ, or emboweling a woman alive, since in this coun-
try, and on the Continent, indeed, that expedient is disapproved
of in the most emphatic language, by those even who performed
it successfully.
We now take leave of Dr Lever by wishing him every suc-
cess in his endeavours to enlighten the profession; and by
strongly recommending our brethren to possess his work, as one
from which the veteran as well as the tyro will derive much
valuable information.
The Physiology of Inflammation and the Healing Process. By
Benjamin Travjbrs, F.R.S., Surgeon Extraordinary to the
Queen, &c. &c. 12mo. Pp. 226.
It is not wonderful that inflammation should occupy so much of
the thoughts of the medical profession. It is the field in which
medicine achieves its most signal triumphs. And should an
occasional doubt arise in the mind as to the reality of the empire
of medicine over diseases, with ordinary discernment, it is most
easily silenced by reflecting on the ravages of acute inflamma-
tion in some seasons, and on the power of the lancet to check its
destructive progress.
No doubt, there are periods, the medical constitution of which
(so to speak) is but faintly distinguished by a tendency to that
highly acute inflammation of vital parts which the lancet so
effectually combats ; and there are times when the pathology of
the day is apt to take one-sided views, and to draw its colour
too exclusively from a few sources, without surveying the whole
of the wide range which diseases occupy.
Even our own time, marked as it is by the extensive diffusion
of medical knowledge, is not exempt from the suspicion of being
subject to some undue influence of this kind. And what with a
THB PHYSIOLOGY OF INFLAMMATION. 51
too exclusive attention to the course of inflammation in hospital
practice,* among patients debilitated by previous diseases and by
the poverty and vices of large towns, what with an unequivocal
defect of the strong disposition to high inflammation in tiie me-
dical constitution of the seasons, for some time past, we are now
and then threatened with the rise of a scepticism as to the in-
herent fatality of acute inflammation when left to run its course.
We cannot give to this temper of mind the praise of rational
doubt. We regard faith in the power of the lancet over the
early stage of acute, unembarrassed inflammation, as the test of
a medical man's soundness of judgment and fitness for the dis-
charge of the trust reposed in him by his patients. And judging
of the future from the past, we feel assured that times will come
round, and that often, when a perseverance in such doubts will
prove the source of bitter repentance to those who foster them.
Next to experience, in a proper sphere, of the effects of vene-
section over inflammation, ranks a careful study of the facts and
events of this morbid action, to preserve a right frame of opinion
over so important a subject. And we augur well" against the
spread of the scepticism referred to, from the extended attention
given at present to the phenomena and pathology of inflammatory
action.
The theory of inflammation has always been an attractive sub-
ject among medical writers. The theory, however, is less im-
portant at present, and less within our reach than the facts. The
work of Mr Travers, which we have placed at the head of this
article, turns less upon the theory than upon the facts and events
of the whole disease. The fault of all our past theories of this
disease has been the too sparing amount of facts founded on.
And numerous as have been the additions made of late years to
our knowledge of such facts, we shall discover, on a very tran-
sient inspection, that it is the want of a few additional facts that
renders it impossible to bring out a satisfactory theory of inflam-
mation. The facts of a disease are not distinct from the theory,
the theory being the facts generalized ; and while a perfect theory
is unattainable, the facts, when they are numerous, as those
ascertained respecting inflammation are, serve nearly the same
uses as a sound theory. And, iu particular, the knowledge of
the facts of inflammation, and that of its theory, have each the
* See Alison in Library of Medicine, yoL i. p. 100.
62 THE PHYSIOLOGY OF INFLAMMATION.
same paramount object in medicine, namely, to fix and extend
the great precepts of treatment, which experience at first sug-
gested.
The theory of inflammation, defective as it may still seem on
a superficial view, is already more complete than that of any
other extensive kind of morbid action. It is already quite abreast
of the physiology of the functions involved in the disease, and
beyond that it plainly cannot pass. Physiologists have not yet
settled the relative shares taken by the heart, the arterial trunks,
and the capillaries, nor the ordinary influences operating on these
last vessels, in the transmission of the blood during health ; or
the facts, in so far as inflammation itself is in question, are nearly
all already ascertained, and prepared to be incorporated with
whatever principle physiology shall point out as apportioning the
moving forces of the blood among the agents concerned.
The discussion so long agitated, whether the vessels of the
inflamed part be in a state of augmented or enfeebled action, may
now be discarded as having served its turn. The terms of this
question are* not precise enough — ^not sufliciently square with
the facts known respecting the state of the capillaries of an in-
flamed part, to admit of an answer in the negative or affiimative,
as regards increased or weakened action.
. As the work which has suggested these reflections has for its
chief object the exposition of the facts of inflammation, we pro-
pose, before going farther into the subject, to endeavour to ex-
hibit, in the form of distinct propositions, a connected view of
what appear to us the most important facts which have been
authenticated in the pathology of inflammation.
1. That there is no increase in the rapidity of the blood's
motion through the capillaries adjacent to the axis of an inflamed
part, except for a short period at the very commencement of the
disease.
2. That the diameter of the same capillaries is diminished
during the time that the more rapid motion continues.
3. That in those capillaries adjacent to the axis of the affected
part, as soon as the inflammatory action is estabUshed, there is
either a very slow motion or a total stagnation of the blood.
4. That the slow motion or stagnation in the capillaries near
the axis is attended with a considerable dilatation, or increase in
their diameter.
5. That ia the capillaries at the periphery of the inflamed
THE PHYSIOLOGY OF INFLAMMATION. 53
part, the blood flows, during the continuance of the disease, with
unusual rapidity, and that in the mean time the diameter of
these capillaries is diminished.
6. That the period which elapses between the commencement
of the temporary acceleration of the blood in the capillaries ad-
jacent to the axis of inflammation, and its retardation or stagna*
tion in the same, varies from a few minutes to several hours.
7. That in the rise of the inflammation, the blood in the cen-
tral capillaries oscillates, or to some extent flows backwards and
forwards, before it finally stops.
8. That this oscillation of the blood, or its forward and back-
ward motion in the central capillaries, soon after the first com-
mencement pf inflammation, is synchronous with the action of
the heart.
9. That no entire blood or blood-corpuscles escape, unless a
breach of continuity in the enlarged capillaries somewhere occur ;
that even the minutest extremities of the capillary vessels are
closed, and effuse their contents through their walls, by which the
entire blood-corpuscles cannot pass, but only the serum, lymph,
or Uquor sanguinis.
10. That the several conditions of absolute stagnation, slow
motion, oscillation, and rapid motion of the blood, are seen at the
same time, on examining the inflamed area from its central axis
to its peripheral boundary.
11. That coincidently with the slow motion or stagnation of
the blood in the central capillaries, its vesicular part or eorpuscles,
which in health move in the axis of the vessels without touching
their sides, separate from the liquor sanguinis, concrete into
masses, and adhere to the inner surface of the walls, so as to
impede all motion.
12. That even after inflammation has advanced thus far —
that is, to the enlargement of the capillaries — ^the stagnation,
slow motion, oscillation, and rapid motion in the capillaries, ex-
tending from the axis outwards, and the separation of the blood-
corpuscles from the liquor sanguinis, their concretion into masses,
and adhesion to the walls of the containing vessels, the motion
of the blood may slowly return to its healthy state, without any
.exudation of liquor sanguinis, hemorrhage, or even effusion of
serum.
13. But when things have come into the state referred to,
that liquor sanguinis, that is, blood freed from the corpuscles
only, most commonly eiAides.
54 THE PHYSIOLOGY OF INFLAMMATIOK.
14. And that this Hquor sanguinis, separating after exudation
into serum and coagulable Ijmph, affords these well-known most
usual products of inflammation.
15. Further, when the stagnation is considerable, that the
fibrine of the hquor sanguinis concretes on the inner walls of the
capillaries, small arteries, and venous radicles, as well as on the
adjacent free surfaces, or in the interstices of the affected paren-
chyma.
16. That by this concretion of fibrine within the vessels, the
stagnation is rendered more complete, extensive, and permanent ;
and hence that total failure of nutrition in the part or gangrene
is threatened.
17. That the repulsion between the red corpuscles and the
liquor sanguinis during inflammation is apparent even in the
blood taken from a vein, giving rise to the buffy coat, to which
there is a stronger tendency, after an inflammation has continued
some time, than at its commencement.
18. That when the effused coagulable lymph, that is, the
fibrine of the hquor sanguinis, becomes organized, as in the case
of adhesion between two free surfaces, or of the thickening
of a membrane, it is by the agency of the red corpuscles that
new vessels are formed.
19. That as stagnation begins to cease in the dilated capilla-
ries, and motion comes to be recovered, separation of the con-
creted red corpuscles takes place, and oscillations or shght move-
ments backward and forward arise, by which single blood-cor-
puscles are projected through the ruptured walls of the capilla-
ries into the adjacent concreted lymph; that the tracks thus
formed gradually pass into loops and arches by the concurrence
of corpuscles projected from different points, which become ves-
sels, and quickly receive files of blood-corpuscles from the adja-
cent old capillaries, in which the blood is recovering its motion.
20. That the granulations in wounds and the pyogenic mem-
brane in abscesses are organized in concrete coagulable lymph on
the same general plan ; while the part so organized exudes or
secretes pus, or if not pus, the fluid material out of which pus forms ;
and it may be that in other instances of suppuration, organized
coagulable lymph performs a similar office.
21. That ulceration is the result of decomposition or absorp-
tion, when that is riot balanced by the activity of nutrition in the
new texture.
22. That the artery feeding an inflamed part and the parts
THE PHYSIOLOGY OF INFLAMMATION. 55
immediately adjacent, beats., more strongly than in health, while
in a giyen time a greater quantity of blood, even by three or
four times, is transmitted through it, as well as by its corres-
ponding vein.
23. That this artery and this vein may generally be dis-
covered by the touch to be more distended with blood than
24. That though an increase in the force and frequency of the
heart's action be not absolutely essential to inflammation, yet
that it is evidently a part of its phenomena in every case in
which the disease is rapid in its progress or extensive in its seat.
25. And that the stroke of the pulse in the radial artery, most
characteristic of the presence of unembarrassed inflammation,
" seems as if it were produced by a number of detached globules
passing in succession through the artery."*
26. That the severity of the symptoms in some external inflam-
mations, as gout, whitloe, and the like, may be relieved, and the
attack even cured, by compression of the artery supplying the
part.f
27. That whatever tends in the early stage to diminish the
fulness of the vessels in the region of the inflamed part, and the
general momentum of the mass of the blood, and when the case
is severe, free venesection in particular, has manifestly a great
power to prevent the effusion of the liquor sanguinis and the
other events of inflammation, by assisting to restore the circular
iion of the part to its natural state.
28. That nothing so clearly shows this as the well-known
effect of excessive venesection to interrupt the progress of the
healing process in the case of wounds and other injuries.
Such, then, are some of the facts, the generalization of which
should constitute a theory of inflammation. . A perfect theory
should in the first place connect the causes of inflammation with
the acts which represent the first stage, and then the first stage
with the subsequent progress of the disease.
The kind of explanation which past experience in the science
of life entitles us to expect, by the cultivation of this subject, is
not a reference of the secret workings of the stream of life, in
its capillary channels, when inflammation has sprung up, to the
same head exclusively with any modes of action known among
* See Parry, Elements of Pathology and Therapeutics, p. 56.
t Parry, Memoirs of the Medical Society of London, voL iii. p. 77 ; i^w Kcllie,
Medical Effects of Compiession by the Toumiquet.
56 THE PHYSIOLOGY OF INFLAMMATION.
mechanical or chemical phenomena, or in any part of pm*ely physi-
cal natm'e. The gromid on which the explanation sought must
rest cannot be any thing else but principles discovered in the
living body itself. Or we obtain an explanation of a particular
act of the living body, whether healthy or morbid, when that act
is shown to be a special instance of the operation of laws before
established by the generalization of facts observed in the animal
economy in health or disease.
While, however, the expectation of reducing the phenomena
of inflammation to any purely physical laws, is plainly chimerical ;
stiU it is not to be forgotten that mechanical principles must
operate in a disease, the very essence of which is an extensive
disturbance of the circulation of the blood. In the circulation
the greatest share of the powers concerned is purely mechanical.
And therefore no theory can be satisfactory, which does not show
how much of the process can be ascribed to mechanical causes,
at the same time that the claims of the purely vital forces are
rightly vindicated. On this point we quote the following pass-
age from the first chapter of the work before us, which Mr
Travers entitles Preliminaries : —
^^ Most of the theories of inflammation are based upon the fact of an obstruc-
tion to the passage of the blood, whatever be the cause, real or supposed, of
such obstruction. Some have represented this remora as mechanic^, others
as chemical, others again as a nervous phenomenon. To constitute inflam-
mation it must be all or neither ; for the mechanical, chemical, and vital
properties are all implicated and altered by inflammation." P. 80.
Under the head of preliminaries falls another question which
some are fond of debating, namely, whether the healing process
be a process of inflammation. Mr Travers argues against the
idea maintained by the late Dr Macartney and some other emi->
nent authorities, who refuse to recognise the healing process as
an inflammation. To us the question appears to be a dispute
about words. It is at present at least merely a question whether
the word inflammation shall Iiave a larger or smaller extent of
signification. The larger use of the term seems warrantable,
because the facts ascertained correspond with the idea that the
healing process, and what is called by contrast spontaneous in^
flammation, are identical in character.
The name which Mr Travers has bestowed on his work. The
Physiology of Inflammation and the Healing Process, suggests
another and very important view of this point. Why the phy-
siology of inflammation ? one might say. What has physiology
to do with inflammation ? What is pathology, if inflammation
THE PHYSIOLOGY OF INFLAMMATION. 67
be not a part of pathology ? In one sense Mr Travers might
reply, Physiology, as standing in contrast to physical science,
and exhibiting the laws of living nature under all possible cir-
cumstances, must include pathology. But, doubtless, what led
Mr Travers to adopt for liis work the title Physiology of
Inflammation, was the influence of the Hunterian views of in-
flammation over his thoughts, — those views which represent
inflammation as an act or suite of acts designed to serve a pur-
pose in the animal economy — a physiological provision without
which death would result from the slightest accidents, while,
during its shortened span, the body would be covered at innu-
merable points with raw and irritable sores.
According to the Hunterian views, the susceptibility of in-
flammation in Uving parts is the reparative power ; inflammation
is one of the oflSces of life — an occasional function called into
activity when injury is inflicted. Such is the normal character
of inflammation. But, like every function of the living body, it
is liable to abnormal states, and these abnormal states are true
states of disease.
But besides bearing on the question whether the healing pro-
cess be a process of inflammation, the view just taken may be
used as a method of investigating the phenomena of inflammation.
We are not prepared to aflSrm this to be the justest light in
which the nature of inflammation can be investigated. Nor can
we deny the tendency of this kind of analysis to lead into some
errors in pathology. But when a due regard is paid to facts,
and a proper discretion exercised over the inferences from them,
we look on this mode of investigatioTi as perfectly sound, and of
a kind to bring out some parts of the process which, by any other
mode of inquiry, might escape observation;
The grand difliculty in constructing a proper theory of inflam-
mation undoubtedly is, to connect the causes with the phenomena
which first arise, or with the dilatation of the capillaries and the
stagnation of the blood. In the production of these, the first
phenomena, it seems to be impossible to dispense with the agency
of the nervous system. The isict on which these phenomena de-
pend must be either in the aflfected capillaries themselves, or in
the contained blood, or in both. For the dilated vessels must
still be subject to the whole momentum of the mass of the blood,
there being no obstacle interposed between them and that mass
to mtercept the effect of its momentum. The contents, there-
fore, of the dilated capillaries, when stagnant, are not stagnant
58 THE PHYSIOLOGY OF INFLAMMATION.
because no longer pressed forward by the momentum of the
blood between them and the heart, but because that momentum
is insufficient to overcome their present inertia. It seems certain
that nervous filaments are suppUed to the coats of the capillaries ;
and there is but one great law of nervous action, namely, that
impressions made on the extremities of certain nervous filaments
are succeeded by influences transmitted from the central organs,
or the ganglionic centres, by which changes on the mechanical
state of distant parts are brought about. It is therefore, at least,
a probable inference, that when the cause of inflammation acts on
the part to be aff'ected, the nerves give origin to those changes
which constitute the first phenomena. The conclusion is here
brought out without reference to final causes, or to the Hunterian
method of investigation. But it would be easy to show that
that method, though it could not teach us that the capillaries
are supplied with nerves, might in so far lead us to the same
conclusion, by pointing out that a process, involving complex
purposes of design, must necessarily be dependent, like acts of
instinct, on nerves, thereby inducing us to search for the nerves,
if these had not been before discovered.
What the nature of the change wrought by the nerves is, we
do not at present propose to inquire. The subject is not so im-
mediately suggested by the work before us as to warrant our
entering on it at sufficient length. And we fear pathology is
still far from the point of fixed knowledge on this subject.
But there are several important subjects of inquiry towards
a complete theory of inflammation, which should engage the
attention of pathologists, or rather of physiologists, even while
the nature and mode of production of the earUest phenomena
are incomplete. Thus, it may be considered, if the distention
of the capillaries and the accumulation of their contents have
an object, — if the exudation of liquor sanguinis and then of red
corpuscles bo the final purpose of this dilatation and stagnation,
— and how far this state agrees with the other known states of
vascular turgescence which precede increased deposition from
the blood, — whether the mechanical force here manifestly ap-
plied through the momentum of the mass of the blood to the
dilated vessels and their contents be the sole cause of the exuda-
tion, or only an assistance by which the effect of a vital act of
transmission is increased.
Again, it has to be determined how far the important pro-
perties of tonicity and elasticity, first of the arterial trunk
THE PHYSIOLOGY OF INFLAMMATION. 59
feeding the affected part, and next of the arterial system at
large, are acted on by the local obstruction. By what steps
does the artery of the inflamed part become distended and
convey more blood than usual ? Is this artery brought more
into the condition of a rigid tube than in its healthy state ? — or
does it still expand under the stroke of the yentricle, and is its
elasticity increased proportionately with its distention, so as to
enable it still to contract on its contents ? Or is the strength of
its pulse independent of any actual expansion under the stroke
of the heart, and is the blood transmitted through it by the
direct impulse of the heart, without any contraction of its own
walls? The whole subject of the motion of fluids through
tubes with elastic walls requires revision. The conmion com-
parison of the elasticity of the arteries to that of the air in the
air-vessel of a fire-engine is wholly deceptive, — ^the cases are
not parallel.
Again, the natural motion of the blood in the capillaries
requires to be better understood. Our facts are too much
drawn from cold-blooded anim^ds ; the circulation of the Bat's
wing is too little studied. The proportion of blood in the
capillary system and the rate of its motion have hardly been
computed. The mere inspection of its movement in the field
of the microscope is quite fallacious, — ^the microscope multiplies
the rate of motion in the same proportion in which it magnifies
the moving bodies and the surfaces over which they move.
Moreover, we cannot "tell whether the red corpuscles keep
the middle of the stream by a principle of physics, or as the
effect of vital influence. In short, we have not yet studied the
physical laws applicable to the motion of such organic fluids as
the blood, which are not true fluids, but fluids loaded with
solid matter.
Further, we know by Poiseuille's experiments that the mo-
mentum of the blood is much the same all over the arterial
trunks and even in the small arteries ; but what do we know of
its momentum in the capillaries ?
But we might go on to weariness with the enumeration of
the points bearing on the theory of the phenomena of inflamma-
tion which still require examination. We propose, therefore,
at once to sum up this article with some account of what the
work before us contains, and with some further extracts, to
show the style in which Mr Travers treats the subject.
The work is not of great extent. It is a duodecimo volume,
60 THE PHYSIOLOGY OF INFLAMMATION.
consisting of twelve chapters besides an introduction, in all
occupying little more than 200 pages. His first chapter turns
on preliminaries, from which we have already quoted one
passage. The second chapter contains his microscopic observa^
tions on the effects, in the web of the frog's foot, resulting from
the application of solution of common salt, of ammonia, and from
an incised wound. In these observations he was assisted by-
Professor Owen. In the seventh chapter he has given a table
of the preparations — now in the Museum of the Royal College
of Surgeons of England — made by the late Dr Todd of
Brighton, to illustrate the progressive stages of the healing
process. And in the ninth chapter, he has given the results of
a repetition of Dr Todd's experiments by himself, with the
assistance of the well-known microscopist Mr Quekett ; with
this difference, that, instead of following Dr Todd's practice of
killing a frog day after day to preserve a preparation of the
appearance of the wounds at successive stages, he permitted each
frog to live, to show, in the same individual, the successive stages
of the healing process. We extract some passages from the
digest of the phenomena developed in the healing process, with
which the chapter terminates : —
^^ Stasis or actual arrest of the circulation is a direct effect of local irrita-
tion, more or less persistent according to tlie degree or shock. Thus, if
unattended by injury to structure, recovery frona it restores the previous
condition, whether inflammation be set up or not. Its local extent, like its
duration, will be according to the amount of the irritation. The circula-
tion is oscillatory at the verge of the stasis ; beyond this it is pretematurally
slow ; and yet farther from the stationary centre it is, or appears to be,
somewhat brisker than natural. The suddenness and completeness of the
stasis determine the acuteness of the inflammation ; it is slowly formed and
imperfect in what are termed congestive inflammations.
" Contingent upon the stasis is the efiusion of serum, or of the liquor
sanguinis, the one or the other according to the nature of the injury in-
flicted, whether of function simply or of structure. If serum only be ef-
fused, the inflammation, if any be present, admits of perfect resolution ; not
so if the efi^usion be of the liquor sanguinis, holding the fibiine of the blood
in solution. This is the distinction between the efi^usions of shock and of
lesion, the nervous and vascular, the inflammatory and non-inflammatory
oedema. The second results from a more considerable and prolonged action
than the first, if both be the efl^ects of inflammation ; but whereas the
aqueous effusion is often unattended by inflammation, the fibrinous effusion
is characteristic and proper to it, whether with or without primary breach
of texture."
" The fibrine effused in a state of solution in the liquor sanguinis only
becomes susceptible of oi^ganization, t. c. capable of permanent incorporation
with the living solid, when separated from the other constituents of the
THE PHYSIOLOGY OF INFLAMMATION. 61
blood. It is incapable of oTganizaiion if effused in combination with ther
blood-corpusclesy as in extravasation or hemorrhage." Pp. 160-162.
" The efFosion of Uie liquor sanguinis from the arterial capillaries is the
first change consequent upon inflammation, either with or without breach ;
it is in either case limited to the extreme verge of vascular action^ or the
boundary line of its arrest (complete stasis). In the act of coagulation
upon the face and sides of the wound, the contained fibrine separates from
the serous portion of the liquor sanguinis, and becomes a crust or mem-
branaceous stratum covering in the wound at all points, the sections of blood-
vessels, nerves, absorbents, &c. This^ then, forms the intermedium of
vascular communication by anastomosis in cases of union by adhemon. It
is an efiPusion entirely distinct from and subsequent to extravasation of
blood, and does not take place until after the act of inflammation is estah-
lished, when the coloured coagulum becomes detached." Pp. 162, 163.
" The second act in the healing process is the separation of the lymph
particle from the blood within the vessel. This is not seen until after some .
time has elapsed, for it is not an immediate consequence of the stasis^ which
may and does continually happen without this separation, or any efiusion
of lymph, as in simple irritation or inflammation of a sound texture without
deposit." Pp. 163, 164.
These passages, we should remark, are not quite continuous
with each other ; neither are those which follow.
^ The elaboration of the organizable lymph appears to become perfected
as it advances, confirming the practical observation, that wounds which heal
slow heal sound. It is quite a mistake to suppose that, in wounds with loss
of substance, the effusion of organizable fibrine constitutes the permanent
material of the new solid. The first deposit effused with the liquor san-
guinis is an amorphous exudation, and presents no such regular figure and
arrangement as the lymph particle which has been separated within the
vessel before deposit. They are, in truth, different in this respect : the
first, or that which forms immediately on the receipt of an injury, and
serves for the intermedium of organization in a close apposition of surfaces
(being separated from the liquor sanguinis with which it is effused), would
not serve as a base for the new solid ; it is soon absorbed, being only a tem-
porary bond or adhesive layer in harmony with the parts, though serving
the important purpose of consolidation by anastomosis of the contiguous
vessels of opposite sides, or union by the first intention ; the second is not
called for in mere divisions of substance, and is not ready if it were ; it re-
quires a higher and long-continued inflammatory action ; it is a permanent,
not a provisional or temporary mean of reparation, — a substantial addition
of structure, not a mere conjunction of parts." P. 166.
What Mr T. terms the lymph particle, is the colourless cor-
puscle, concerning which so much discrepancy of opinion has of
late existed. These colourless corpuscles exist at all times in
the blood, but accumulate, under inflammation, in the capillaries,
in which the blood moves slowly, or has begun to stagnate. We
have given Mr T.'s views on the subject of the part assigned to
the lymph particle in the healing process ; but our space does
62 THE PHYSIOLOGY OF INFLAMMATION.
Bot permit us to enter at present upon an examination of his
opinion.
Two quotations more must conclude our notice of this chapter.
** To conclude : the inflammatoTy exudations are, — ^Ist, of serum ; 2dlyy
of liquor sanguinis ; Sdly, of fibrine, or the material of new structure ; and
the &bricator of the new TesEiel is the blood-corpuscle." P. 169.
*^ The temporary stasis seems to be necessary to the exudation of liquor
sanguinis, its continuance to that of the separated lymph particle ; and not
less the graduated impulse of the returning circulation to the elimination
of the blood-corpuscle in single globules for the fabrication of new vessels ;
for if it were in mass (hemorrhi^) it would destroy instead of promoting
organisation." P. 169.
Besides the chapters already referred to, there is one on the
local symptoms of inflammation, one on its constitutional symp-
toms, two on the processes of inflammation, effusion, and adhe-
sion, one on granulations and pus, one on ulcerative inflamma-
tion, one on cicatrization, and the last on gangrenous inflamma-
tion and gangrene. These chapters contain throughout many
observations, which, did our limits permit, we would gladly
quote for the benefit of our readers. We must, however, refer
them to the book itself.
It is impossible for a man who, like Mr Travers, is at once
profoundly read, an original thinker, an industrious experimen-
ter, and a practical surgeon, to write a book on inflammation
which should not be of the highest interest. Yet we cannot
promise that it will become very popular with the profession.
It is not a book which one who runs may read. It requires to
be studied to be understood. Amidst a great deal of clear state-
ment and methodical dealing with the subject, there are occasional
obscurities very discouraging to the reader. But we are sure if
the book be read from end to end, no one will fail to carry away
with him all that the author wishes to inculcate.
The work, however, does not the less merit attention, when
we consider the deservedly high reputation of the author, that
some of his views do not coincide with those generally taught.
There is no part of the whole subject of inflammation on
which there exists so much difficulty and obscurity as the nature
of suppuration and the origin of pus. And we have accordingly
been much interested by the chapter before referred to on gra-
nulation, pus, and suppurative inflammation. And yet we do
not find it easy to pronounce a positive opinion on his views.
^ The granulation is a mesh of the terminal loops of capillary pencils^
formed, as has been described, under the adhesive inflammation in tho
THE PHYSIOLOGY OF INFLAMMATION. 63
newly deposited fibrinous membrane coaUng the suifiice of tbe breach or
cavity in the original solid/' P. 110. ^ The aspect of the suppniating
membrane also varies to sach extent as scarcely to exhibit, in some cir-
cumstances and situations, the granular form, e»g. upon the vralls of ab-
scesses and upon the free surfaces of mucous and serous membranes ; but
the fibrinous bed and the capillary loop of new formation, and a correspond-
ing alteration of the pus-secreting surface from its normal state, will always
be detected upon careful examination, being essential elements of the sup-
purative process." P. 111.
It will strike every one that what he says here is most doubt-
ful as respects the suppurative inflammation of mucous mem*
branes. It is quite true, as Dr Hodgkin says, ** that when the
mucous membrane has been for some time pouring out a more or
less puriform secretion, its surface, although no abrasion or ulcer-
ation may have taken place, becomes irregular, from an infinite
number of rounded elevations or granulations, which are generally
extremely minute, but bear a close resemblance to those which
are formed on the surface of a healing ulcer ;"* but still this
does not carry conviction that pus is never thrown out by the
mucous surface, without the previous deposit of coagulable lymph.
Moreover, we find that Mr Travers modifies the view exhibited
in the passage before quoted by some subsequent passages. The
first passage, however, which we shall cite from his work,
rather goes beyond that above referred to.
^ If, upon careful inspection of the free sur&ce of mucous membrane
secreting pus, no appearance exactly resembling granulation can be observed,
the membrane is ^tered, t. e, raised and thickened by a deposit of hyper-
vascular lymph in the interstitial or subjacent tissue."
How much the following passage, nearer the end of the book,
modifies the two which have been already cited on this subject,
will be at once apparent.
^ The open-mouthed follicles of the mucous membrane are equivalent to
granulations, t . e, equally secrete pus, in lieu of their proper secretion under
inflammation. This shows that the especial form of granulation is not in-
dispensable to the secretion, though it is a form which the efiiised fibrine
more or less afiects, when suppuration is set up." P. 171.
We suspect that the last-quoted passage gives up the doctrine
maintained in the previous part of the work, namely, that pus
is a secretion performed by a temporary secreting apparatus
produced by effused lymph, and that the granulation of open
surfaces is the type of that peculiar gland. Nevertheless, the
view taken by Mr Travers on the subject of the production of
* Hodgkin*8 Lectures on Serous and Mucous Membranes, vol ii p. 28.
64 THB PHYSIOLOGY OF INFLAMMATION.
pus, deserves to be tried by farther experience before it is
condemned.
We shall close this article with a few short extracts from the
chapter " On the effects of inflammation on the system," which,
representing the ideas of a man of so great judgment and ex-
perience as Mr Travers on the treatment of inflammation, can-
not but be acceptable to our readers.
^^ In the fever attending inflammation of the vital organs and their in-
volucra and chambers, the free detraction of blood is one of the most im-
portant points of treatment, and this whether inflammation results from
injury or other causes. The life of the patient seems, in a great measure,
contingent upon his power to bear, and his susceptibility of relief from the
loss of blood— conditions which are not at variance— at first in larger and
afterwards in smaller quantities." P. 57.
'^ In inflammations, however originating, whether from injury or diseased
habit, affecting the extremities, general bloodletting is seldom advisable, or
even practicable with safety. From the part blood is taken, by various
methods, with very great advantage in such cases." P. 57.
** In visceral inflammation, venesection is indicated and warranted to the
utmost extent that the powers of life will bear ; for here the mass of blood
is so altered and spoiled for its proper healthy purposes, by the direct im-
plication of the blood-making and blood-preparing organs in the disease,
that relieving the system of its presence to the extent tiiat can be borne, is
the main resource we possess for its preservation." P. 58.
We fully agree with Mr Travers as to the imperative neces-
sity for the detraction of blood " to the utmost extent that the
powers of life will bear," but we hesitate to subscribe to the
reason assigned in the above passage for the practice.
" There are two false doctrines concerning blood-letting for inflammation,
which cannot be too strongly condemned : the first anticipatory blood-
letting, by which I mean, the large and repeated deti-action of blood before
inflammation, being considered inevitable, has actually manifested itself
on the hypothesis of starving the action, and thus rendering it tractable
which is a direct attack on the vitality, and fatally perverts the action, if it
do not destroy the resisting powers^f the system. The second, continuing
the employment of the lancet so long as the last drawn blood exhibits the
signs of inflammation, which, if drained to the last drop it would do ; or iu
other words, not reflecting that there is a line beyond which the practice
becomes destructive, instead of remedial ; and that there are many inflam-
mations which do not admit of arrest by depletion, and upon which other
modes of treatment are efficient for this end, even though not an ounce of
blood be drawn." P. 59.
With these remarks and quotations, we leave this book in the
hands of our readers ; to such of them as have leisure for the
study of so small a volume, we recommend it as full not only of
descriptive knowledge, but also .of abundant food for speculative
reflection.
ANATOBIY AND PHYSIOLOGY. 65
Part III— PERISCOPE.
ANATOMY AND PHYSIOLOGY.
Medicins at the present time appears to stand npon a yeiy doubtfiil basis ;
its position being marked hj a great want of knowledge conceming the
nature of disease. Correctly speaking, medicine has not yet become a
scieDce. If this statement be untrue, why is it that doctrines such as those
of homoeopathy and hydropathy, so opposed as they are to the received
doctrines of our profession, are permitted to pursue their present progress-
ive course unchallenged ! We say unchallenged, because it appears to us
that all which has been written against these and other crude doctrines has
not exposed in any one point the real nature of such errors. Why is this
the case ! It is because medicine is not a branch of knowledge regulated
and controlled by known general laws. If a person of fancy and genius
gave forth to the world, with great eloquence and reasoning, a work in
which he endeavoured to prove the correctness of the old belief that the
earth is the centre of the universe, and at rest, and that the celestial orbs
must all move in perfect circles and with a uniform motion, would not
such a work be proved to be erroneous from the very nature of things ! And
would not this proof be capable of being made so satisfactory to the most
common mind, as to make that mind scoff at the powerful reasoning and
great eloquence by which the newly resuscitated notions had been dressed
up 1 We again ask the question, Why is this ! It is because the science
of astronomy is regulated and controlled by known general principles. The
physician is at the present time in the humiliating position of the boy in
the theatre, who sees the scenery on the stage continually shifted, and with
the shiftings differences in appearance, but who is entirely ignorant of the
mechanism or mode by which these several changes are effected. In the
same poation stands the physician ; — ^he enters the patient's room, — ^lie
watches the countenance with anxious care, — ^he feels the pulse, and ob-
serves the tongue, and then using these signs as we do the words of a lan-
guage, he becomes acquainted with the ravages that are going on within.
But what does he know of these ravages ! The principal parts of the cata-
logue may be stated to be as follows : — A certain organ is diseased — ^the
progress of the disease is learned — an abnormal action is going on, the effect
of which will probably be a complete disorganization of the organ so diseased.
This is all he knows, — at least all that he knows is of this character. He
is acquainted with the effects merely ; the nature — the mechanism by
which these effects have been produced, are to him, at present at least, as a
sealed book. Thus it is that many baneful and truly fantastic hypotheses
reign rampant for a while, until some new favourite of the same type steps
in and knocks the now friendless theory from its former high position to rest
in forgetfulness. Medicine as a science cannot now be advanced one step
hy mere observation at the bedside, or by coarse anatomical dissections made
in a large hall with large knives. Medicine can only now be advanced
through the aid of the physiological anatomist and the organic chemist. On
66 ON THE STRUCTURE OF THE NERVOUS SYSTEM.
them, in the present day, depends the true advance of medicine. The fonner
must, by careful observation and mechanical analysis of the phenomena of
life and organized matter, acquaint us with the forms which nature gives
to matter while producing beings, while developing them, and while retain-
ing them in health. And the latter must, by his analytical and synthetical
processes, reveal to us the laws which regulate them in the producing of
those various forms with which the physiological anatomist has made us
acquainted. For the fulfilment of these noble objects, men are required
whose whole hearts are devoted to medicine as a science.
We give these few remarks in our first number for the purpose of mak-
ing our readers acquainted with the objects which we shall always have in
view in the physiological department of the Periscope, namely, to endeavour
to bring to bear upon the nature of disease all physiological, oi^nic, chemi-
cal, and microscopic discoveries.
On the Structure, Relations, and Functions of the Nervous System,
There is contained in the last published part of the Philosophical Transac-
tions of the Royal Society of London a very admirable paper, by Mr New-
port, upon the structure and functions of the nervous system, and on the
existence of a complete circulation of the blood in vessels, in some of the
articulata. We intend to give here some extracts from that portion of
the paper which relates to the nervous system, as it illustrates the functions
of a certain portion of that system in man.
^' In all the articulata two modes of development of the nervous system are
in operation in the same animal : — first, that oi growth, or simple extension
and enlargement of each individual part ; next, that of aggregation, or the union
of two or more parts to form particular divisions or regions of the body. The
brain of the myriapod or centipede is formed by the aggregation of separate
ganglia placed above the oesophagus. The first pair of ganglia are always
the smfdlest, and give origin on their front to the nerves of the antennae ;
the second pair immediately behind them constitute the organs of volition,
and represent the brain of the vertebrata. They are attached at their
under and external surface to the central nervous cord by two bands of
nervous matter, which are prolonged downwards on each side of the pha-
rynx, and constitute the crura cerebri.**
"Structure of the Cord, — The cordis a compound structure, composed, first,
of two distinct longitudinal columns of fibres, which are quite distinct from
each other, although closely proximating together ; secondly, of fibres that
run transversely through the cord ; and, thirdly, of fibres that run longi*
tudinally in part of their coui'se at the side of the cord, and enter into the
composition of all the nerves from the ganglia. These fibres I shall desig-
nate the fibres of reinforcement of the cord."
*' The Superior Longitudinal or Aganglionic Set of Fibres. — These fibres I
formerly described as the motor tract. The function of volition seems still
to be accorded to them by Valentin, Carpenter, and Baly. They extend
as a separate fasciculus along the upper surface of the cord. On a cursory
inspection, this tract of nervous matter does not appear to give oflF any
branches, but seems to pursue its course uninterruptedly along the whole
length of the cord. It does not indeed give off filaments to the nerves from
a ganglion while passing over that swelling, but immediately the fasciculus
has passed over the ganglion, it gives off filaments that proceed to the nerves
of the next ganglion."
I
ON TH£ STBUCTURB OF THE NE&VOUS SYSTEM. 67
" Inferior LongitudiTial or Ganglkmc Set of Fibres of the Cord, — ^This por-
lioii of the ooid affords many inteiesUng consideiations. It is placed ex-
letly as in insects, on the under sorfiEbce. It is formed of a longitudinal
leiies of fibres^ like the upper tracts firmn which it is divided by some of the
ibres tbat pass transyersely through the cord. There is one £ust of great
Aiportance as r^ards this gaoglionic series of fibres. Almost the whole of
lie fibres of which it ib composed are traceable directly through each en-
vgement of the cord, which they mainly assist to form. At the interior
part of each enlargement the diameter of each fibre, or fasciculus of fibres,
appears to be slightly increased, and its structure becomes more softened
and delicate."
. ^ These are the structures to which I formerly assigned the function of
Volnntary motion and sensation, and to which I am still inclined to believe
they minister, since the fibres of which both are composed are traeeabk to
flie crura and brain.''
*^ Those fibres of the cord which seem to be independent of the sets just
leseribed, and which do not appear to have any direct communication with
the great seat of sensation and Toliti<»], the brain, are of two kinds^
^ vhieh may justly be n^j;arded as innoluntary in their functions. The first
i. these ace the eommieeural fibres which pass through the gauglia ; and
; he second, or those which have hitherto been undescribed, and which form
he sides of the cord in the interspace between the ganglia, the fbree of
wtforeement of the eord*^
'* TkeFUnwofBemforeementofiheCord,'--'The9dhhTes£[>TmihelB^^^
^ lioBs of the whole nervous cord of the body, and enter into the composition
I If all the nerves. They constitute, as it were, circles of nervous oom-
vmnication between two nerves that originate from the cord at a greater
I m less distance, and form part of the cord in the interval between these
' ienres, and bear the same relation to the s^:m^ts individually which the
loid itself does to the whole body. They form a part of the nervous trunks
irhich come off from its aganglionic tract, as well as of those which pro-
teed from the ganglionic tract. In this manner these fibres of rein-
feieement connect all the nerves of the cord on one side of the body, as
te correqionding fibres do on the opposite side. They form as it were
Vmble, treble, or quadruple circles, one within the other. Thus the fibres
Sai pass inwards along one nerve, may proceed along the cord to pass out-
"uds again on the front of a seccmd, a third, or a fourth, thus linking the
Kgrnents in one continued series of nervous communications, independent
of the brain. But these communications exist only between nerves on
the same side of the body, and not between those on the opposite. The com-
miuural nerves connect the opposite sides of each individual segment, as
those of reinforcement do the same sides of two separate s^;ments."
** Every nerve from a ganglionic enlargement of the cord is thus composed
of four sete of fibres, an upper and an under one, which communicate with
the cephalic ganglia ; a transveise or oommiesuraly that communicates only
with the corresponding nerves on the opposite side of the body ; and a lateral
set, that communicates only with the nerves on the same side of the body.
The fanctions of the two last-mentioned sets must be regarded only as
leflex ; entirely independent of sensation, but capable of being excited into
action by external causes.**
''The existence of these lateral fibres in the cord may now fuUy explain
the reflected movement of parts anterior or posterior to an irritated limb
on the same side of the body, as the conuuifisnral ones do the movements
68 ON THE STRUCTURE OF THE NERVOUS SYSTEM.
of parts on the side opposite to that which is irritated. The presence of
these fibres in the cord of insects I had long suspected, from the cnrred
direction of the fibres that bound the ganglia, and from that of the origins
of the nerves from the aganglionic tract, as figured in my former paper ;
and although I had communicated this opinion to a friend seyeral years
ago, I have never until recently been able to satisfy myself of its correctness."
^^ This uncertainty of the existence of any structure in the cord that seemed
sufficient to explain the reflected movements on the same side of the body,
independent of the brain and the nerves of volition and sensation, long
obliged me to withhold my assent to the doctrines now received respecting
these phenomena."
^^ Although the fibres that pass transversely through ganglia might explain
the effect produced on one side of the body by the irritation of a correspond-
ing part on the other, there seemed no anatomical structure to account for
the movements of distant parts, anterior or posterior to a given point, on
the same side, if the doctrine long received, that each fibre is endowed with
but one special function, were correct. Now, therefore, that we find an
anatomical structure in the cord that seems to account for these pheno->
mena, it ought in justice to be stated, that Dr Hall, to whom is due the high
credit of collecting, comparing, and arranging in one system numerous facts
connected with the reflected movements of animals, as observed by Whytt,
Blane, and others, and also by himself, — adopting the principle established
by our distinguished physiologist. Sir Charles Bell, that every nervous fibre
is continued unbroken from i^ origin to its termination, and is capable of
ministering only to one special function,— -conceived the necessity for the
existence of special nerves for the reflected movements."
{To be continued.)
SURGERY.
(holscheb's hannoversche annalen.)
Memoir on the Diagnosis of Cancer of the Eyelids. By Dr Canstatt of
Ansbach (now Professor at Erlangen).
A SERIES of observations collected at the Ophthalmic Clinic of M. Sichel,
whose assistant he was for a considerable time, has led Dr Ch. Canstatt to
the following conclusions on the diagnosb of cancer of the eyelids.
Progress of the Disease. — The progress of this disease presents numerous
varieties ; but it appears that its course is much slower in the eyelids than
in any other region of the body. Often years elapse without the soirrhus
gaining either in breadth or in depth. However, no means either pharma-
ceutical or surgical has the power of repressing or checking it. Ou the
contrary, every attempt of this kind ends in hastening the transformation
of scirrhus into open cancer. The stationary state of the ulcers of the lids
has been already pointed out by Jacob as a sign of their cancerous nature.
Original Seat of Cancer of the Eyelids. — Most frequently the original seat
is in the palpebral conjunctiva, and from thence it attacks the skhi on tha
other side of the palpebral edge. Sometimes the skin is affected first. The
affection may be considered as glandular scirrhus when it commences in
the lachrymal caruncle.
The frequency of cancerous ulcerations at the Internal angle of the eye
CANCER OF THE EYELIDS. 69
Is very remarkable. This fact is e^lained by the use of this angle, which
Benres as a receptacle tbr the difierent secretions of the conjunctira and of
the glands of the lids.
Primary Affet^itmt iMch give rise to Cancerous Ulcerations. — ^It is very
rue to see a tabercular excrescence of the conjunctiva degenerate into
cancer. Most commonly an ulcer, of at first a simple appearance, degene^
rates, either in consequence of an irritating treatment, or under the in-
fluence of an unhealthy constitution of the patient. An advanced age,
want of cleanliness, or the cessation of the catamenia, exercise a well-marked
influence on the modification of the character of these ulcers. The cuta-
neous scirrhus of the eyelid is frequently developed, as in other regions of
the body, as a consequence of a tumour which only differs from an ordinary
wart in the lancinating pains of which it is sometimes the seat. On this
account, it is necessary to extirpate excrescences of tliis nature as soon as
ihey make their appearance. The ravages of cancer of the eyelids may ex-
tend themselves in a firightful manner. Sometimes the sufferings of the
patient are terminated by death, in consequence of an affection of the bones
and of the membranes of the brain.
Appearance of the Cancerous Ulcer of the Eyelids. — ^The bottom of the
ulcer, often foul, is covered by crusts which are detached spontaneously, or
are torn off by the patient, and which may give rise to hemorrhages. These
cmsts gun insensibly in breadth whilst the ulcer becomes deeper. Often
all the parts capable of carcinomatous degeneration are transformed into
tubercular masses before the ulcer becomes open ; but this when once esta*
blished causes the most rapid destruction. Sometimes the invasion of the
neighbouring parts takes place by paroxysms of exacerbation, after the dis-
ease has been for a certain time stationary, and even when hopes of a speedy
cure have been entertained. The skin is rarely inflamed far beyond the
limits of the ulcer, and does not undergo any scirrhous modification. Rarely
are these fungous excrescences which abound in affections of this nature,
having their seat in other regions, seen to elevate themselves from the bot-
tom of a cancerous ulcer of the eyelids. This is the more remarkable, as
in the eyelids the surface of the ulcer is exposed to a continual irritation
fix)m the contact of the air and the secretions of the eye. Hemorrhage sel-
dom complicates these ulcers, which do not furnish such a sanies and such
a tainted secretion as an open cancer does in other regions of the body.
Practical Conclusions. — ^Every ulcer of the eyelids ought to be operated
on at an early period, which presents a suspicious character, if, not yielding
to rational treatment, it remains stationary or makes fresh progress. The
operation, when performed in time, permits the hope of a perfect cure of
cancer of the eyelids ; whilst, if temporized with, it threatens, during its
existence, not only one of the most important organs, but even life itself.
The opinion of M. Canstatt is conformable to that of Jacob, who declares
that every therapeutic agent other than the employment of the bistoury,
ought not to be applied for the treatment of cancer of the eyelids. Caute-
rization, especially by means of the arsenical paste, which is justly recom-
mended for the treatment of cutaneous cancer in other parts, as the nose,
lips, &c., ought not to be practised, except in an extremely cautious manner,
in the case of cancer of the eyelids. Not only does the danger of its second-
ary action upon the eye contra-indicate its employment, but besides, expe-
rience does not appear to have verified in this case the success due to it in
the same affection when it has its seat in other parts of the body.
Annales d^Oculistique^ Fevrier 1844,
70 NEW PREPARATIONS OF IRON.
MATERIA MEDICA AND DIETETICS.
On the Preparations of Iron recently introduced into Practice.
The preparations of iron are most deservedly in high esteem with practical
medical men. The reputation of these preparations, in the treatment of
diseases, has prohahly varied less for a long time past than that of most
remedies of similar pretensions. There are, indeed, some indications of
their having heen held for a time, since the commencement of this cen*
tury, in a degree of suspicion with a part at least of the profession. And
this suspicion seems to have arisen from their well-known power of acting
as a stimulus to the vascular system — of increasing the force and frequency
of the heart's action, — a property which was naturally enough thought to be
incompatible with Iheir use in any chronic disease, where by possibility
there might be inflammatory action secretly going on.
But it seems now well established that there are chronic diseases attended
with some degree of the inflammatory process, for example, chronic inflamma*
tion of the mucous membranes, chronic diarrhoea, chronic dysentery, enlarge-
ment of the liver or spleen, and ulcerations of the surface, in which those con-
ditions are present that determine the utility of the preparations of iron.
Besides, it was more the practice some years back than it is now to describe
morbid alterations of tissue, such as so often characterize chronic diseases^ to
inflammatory action. And if the recent introduction of the term diseased
nutrition, to represent a part of the morbid agency in the production of
textural alterations, before referred to inflammatory action, has been of no
other use, it has at least left us more free to observe the effects of remedies
on nmny chronic diseases, without the bias given to the mind by the ideas
which inflammation cannot but call up.
As respects the preparations of iron, however, in diseases generally, the
risk at present is, from the universal attention paid to them, that their use
will be carried beyond just bounds^ rather than that they shall be employed
less than they deserve.
And yet the indications for the use of iron in diseases have always been
tolerably simple, and perhaps it is not premature to pronounce that these
are already becoming still more simple tiian before. We refer to the exact
evidence recently brought forward of what has been conjectured for many
years past, namely, that iron used as a remedy goes directly to the nutrition
of the blood, when the blood has fallen into an impoverished state. On
this subject the memoir of Andral and Gavarret is highly interesting, as
well as Andral's more recent little work entitled '^ Hematologic."
It is hardly too speculative, when we look to the facts detailed in the
memoirs just referred to, to represent the state of the system which calls
for the use of iron in the following manner : The iron of the blood, in the
healthy state of the system, is drawn from the organic matters containing it
employed as food ; but in certain states of ill health the nutritive powers
become inadequate to extract a sufficiency of iron from the ordinary food,
for the maintenance of the blood in its perfect state ; while, if iron be given
in the mineral state, the blood becomes restored more or less quickly to a
healthy constitution. Thus, then, under this view, iron becomes an ali-
ment rather than a medicine ; or, like common salt and water, it is an ali-
ment from the mineral kingdom.
Hence, besides the old indications for the employment of iron drawn
from the languor of the circulation, the inactivity of the respiratory acts,
and the depression of the nervous system, we obtain in addition the im-
poverished state of the blood or the proportionate deficiency of the red
NEW PREPARATIONS OF IRON. 71
corpnsdes, — a deficiency which may be ascertained with or without the use
of the microscope. The same view affords a satisfactory rationale of the
difference between the efiects of iron as a stimulant on the living system
and those of such stimulants as alcohol, opium, and the like. The latter
agents, like iron, increase the force of the circulation, the activity of the
respiratory acts, and the enei]f!;y of the nervous system, while digestion,
secretion, and absorption, participate in the general excitement, and the
whole system feels a fresh tone. But these effects are short-lived ; there
is expended on them much of the ordinary resources destined to maintain
the body in vigour for some time to come, and hence, present exhaustion
must ensue. There is a collapse of the system, marked by languor of the
circulation, deficiency of respiration, abatement of the healthy vigour of
secretion, and depression of the muscular tone.
And the reason is, because the last-named stimulants possess little or no
nutritive property. The excitement they produce is necessarily, therefore,
a process of exhaustion ; unless, indeed, the system has previously fallen
below its healthy standard, in which case such stimulants act the part of
permanent tonics, by bringing the functions of maintenance nearer to the
level of healthy vigour. But the preparations of iron, under the view above
referred to, not only stimulate, but at the same time supply to the blood the
means of sustaining the expenditure of substance produced by their stimulus.
Bat enough of these generalities : we propose to give a short notice of the
preparations of iron recently brought into use.
Notwithstanding the difficulty of preventing the protosalts of iron from
passing spontaneously into the corresponding persalts, a very general belief
has sprung up that the former are of greater utility in a medicinal point of
view than the latter. It is true that the rust of iron and the old precipitated
carbonate are known by long experience to be beneficial in diseases, and it
is equally certain that the discovery of chemists that they are not carbon-
ates cannot invalidate their claim to this title* Why then, it may be asked,
take so much pains to exhibit iron in the form of a true carbonate, if there
be no experience till of late of its utility, while there is the experience of
many years in favour of the sesquioxide into which the carbonates spon-*
taneously pass ! But since it is quite possible that, while the sesquioxide
is useful, the true carbonate may be more useful, let us consider on what
ground of experience the latter persuasion rests. The antihectic mixture
of Griffiths, represented officinally by the compound mixture of iron and
by the compound iron pills, has, from an early period, enjoyed a high re-
putation among practical men, in spite of the efforts of chemists and phar-
maoeutistsy who rest their opinions on theory too little qualified by ex-
perience in the actual treatment of diseases, to banish it as unscientific.
It is now found that this supposed unscientific mixture is the only form
in which we have any long experience of the medicinal effects of iron in
the state of carbonate. And hence arises a probability that the reputation
of the compound iron mixture in diseases depends on the iron being in the
state of carbonate of the protoxide. It is retained in that form by the
presence of sugar, whichj according to the singular discovery of the Greiman
chemist Klauer, prevents the decomposition of the carbonate of the pro-
toxide by preventing the protoxide from passing into the state of sesquioxide.
The same statement applies even more forcibly to the solid form of the
same combination, the compound iron pills, or Griffith's pills.
Previous to the announcement of Klauer's discovery, Dr Clark of Aber-
deen had proposed to preserve the precipitated carbonate from passing into
sesquioxide by avoiding any drying of it, and making it at once, after
72 NEW PREPARATIONS OF IRON.
merely sqaeezing it, into an electuary with sngar and aromatiiss. And Dr
Chi'istiaon had also preyiouBly observed, that the iron of this electuary had
not lost its carbonic acid even when it became quite dry.
In the first English edition of the Edinburgh Pharmacopeia, advantage
was taken of Klauer*s discovery, and a saccharine carbonate of iron intro-
duced. This saccharine carbonate is found to be a mixture of the carbonate,
of the protoxide, and the sesquioxide. A pill of the saccharine carbonate
was introduced at the same time. Many practitioners have of late adopted
the use of the carbonate of iron made extemporaneously at the moment of
being taken. The formule for this purpose contain some soluble salt of
iron, with an alkaline carbonate, as the solution of the sulphate with the
carbonate of soda. From 8 grains of sulphate of iron, and 10 grains of
carbonate of soda in solution, an effervescing draught is obtained, contain-
ing ten grains of carbonate of iron. The tincture of the muriate is also used
in the same way with an alkaline carbonate. Besides these preparations,
the sulphate and the black oxide contain iron in the state of protoxide,
combined in the latter with the sesquioxide. Or the London Pharmacopeia
contains three preparations in which the iron is In the state of protoxide,
namely, the mistuia ferri composita, the pilulie fern composits, and
the sulphate of iron ; while the Edinburgh Pharmacopeia contains the
same, with the exception of the piluls ferri composite, and has be-
sides the saccharine carbonate, the pills of the saccharine carbonate, and
the black oxide, now made by precipitation after the formula of Wohler.
More recently it has been found that sugar has also the effect of pre-
serving the protiodide of iron from passing into the periodide. And this
discovery has been taken advantage of in tho new preparation of the Edin-
burgh Pharmacopeia, the ferri iodidi syrupus.
The most important new officinal preparation in which the iron is in the
state of sesquioxide, is the hydrated sesquioxide, termed, rather unhappily
we think, by the Edinburgh College, Ferrugo. This is the substance r&*
commended as an antidote to arsenic, and it will most probably be found to
supersede the common rust and the sesquioxide formed from the precipitated
carbonate.
Besides these officinal preparations, many others have been recommended
of late, and some have come into use.
The following table includes those more worthy of notice : —
Dose.
Ferri bromidum, • . * • . gr, iii. to gr. viii.
Pilulae ferri bromidi, gr. i. in each.
Ferri citras, gr. v. to gr. viii.
Ferri ammonio-citras, . . , , , gr. v. to gr. viii,
Ferri et Quine citras, gr. iii. to gr. vi.
Aqua chalybeata (citrate of iron in water charged
with carbonic acid and flavoured with aromatics), ^ii.
Ferri potassio-citras gr. v. to gr. viii.
Liquor ferri potassio-citratis.
Ferri tinctura aurantiaca (iron filings^ SeviUe
oranges, Madeira, &c.), . . . . 3i. to §ss.
Ferri lactas, gr. vi. to gr. xii. in the day.
Ferri lactatis syrupus.
Ferri lactatis trochisci.
Ferri ammonio-tartras, , , , . gr. v. to gr. viii,
Ferri tannatis syrupus.
Ferri con&ctio composita, .... gss.
NBW PREPARATIONS OF IRON. 73
The bromide of iron is deliquescent and very soluble. The dose is from
8 to 8 grains. The pills are made with a g. s, of extract of liquorice, each
contaimng one grain of bromide. Their use is against glandular enlarge-
mentfl^ hypertrophy of the uterus,* &c.
. The citrate and ammonio-citrate of iron have been met with in the shops
for some time« The citrate is permanent in air, sparingly soluble in water,
very soluble in boiling water, and the solution reddens litmus>paper. The
ammonio-citrate is deliquescent, soluble in cold water, neutral to test-paper.
The citrate is made by saturating a hot solution of citric acid with moist
hydrated sesquioxide of iron ; cmd the ammonio-citrate is made by adding
enough of aqua ammonis to the same solution to render it neutral.
The citrate of iron and quinine is made by mixing 4 parts of citrate of
iron with 1 part of citrate of quinine. The citrate of quinine is made by
dissolving pure quinine in a solution of citric acid.
The ammonio-citrate, as soluble, is preferable to the citrate. The dose of
either is from 5 to 8 grains. The ammonio-citrate should be given in solu-
tion. The dose of the citrate of iron and quinine is from 3 to 6 grains.
The form of pill answers best for this medicine. The uses of these prepara-
tions are much the same as those of the tartrate.
The aqua chalybeata, made by Bewley & Evans of Dublin, contains 13
grains of citrate of iron in 6 oz. The dose is 2 oz. two or three times Srday.
The tinctura ferri aurantiaca is contained in the Wirtemberg Pharma-
copeia. It is an agreeable preparation, the dose being from one drachm to
halfan ouncet.
The ferri potassio-citras and its syrup are recommended by Dr Todd, and
the mode of preparing them may be seen in the Lancet, 10th September
1842, p. 822.
The lactate of iron contains the protoxide. It is met with in small aci-
colar greenish prisms, or in powder of a pale green colour. It contains 3
equivalents of water of crystallization. It is sparingly soluble, and during
solution passes into a higher state of oxidation. It is made by adding iron-
filings to lactic acid. The syrup and lozenges are made on the common
plan. The dose of lactate of iron is from 6 to 12 grains in 24 hours. Use
in chlorotic diseases, atonic amenorrhoea,:^ &c.
The syrup of tannate of iron is made from citrate Of iron by adding sim-
ple syrup, syrup of vinegar, and extract of galls. The iron is said to be in
the state of protoxide.§
The ferri ammonio-tartras occurs in brilliant scales, semi-transparent, and
of a reddish brown colour. It is soluble in cold water. It consists of one
equivalent of tartrate of protoxide of iron, one equivalent of tartrate of
ammonia^ and four of water. It is made by adding hydrated sesquioxide
of iron to a solution of tartrate of ammonia. It is permanent in composi-
tion, and is given to the extent of from 5 to 8 grains, in powder,
pill, or solution. It is recommended chiefly in derangements of the
uterine organs. ||
• See Neligan, Conspectus of the Pharmacopeias.
t See Medical Times, 11 th March 1843, p. 386. London and Edinburgh
Journal of Med. Science, January 1843. Neligan, Conspectus of the Phar-
macopeias.
X Memoir by MM. Oelis and Coute ; also Medico-Chirurgical Review, October
1840, p. 511 ; and Neligan, Conspectus of Pharmacopeias.
§ See Medical Times, 11th March 1843.
i) See Procter in American Journal of Pharmacy ; also Neligan*8 M&t. Med. p. 359.
K
74 TREATMENT OF ACUTE RHEUMATISM.
The confectio ferri composita, made aooording to a formula given by Mr
Heathcote of Gosport, contains clinkers, the scorie got from the blacksmith's
shop. These appear from several accounts published of late years to have
been long a popular remedy. Mr Heathcote says that they are much used
in Bath under this form.
Take of clinkers reduced to an impalpable powder, 8 oz. ; carbonate of
magnesia, ^ oz. ; powdered ginger, 1 drachm ; treacle, a sufficient quantity ;
make an electuary ; ^ oz. for a dose.
PATHOLOGY AND PRACTICE OF MEDICINE.
On the Treatment of Acute Rheumatism.
The number of remedies proposed for the treatment of any disease is usu-
ally in proportion to its obstinacy ; and, accordingly, while innumerable
cures have been recommended in acute rheumatism, it is a disease which in
many cases baffles our art. When we examine the various authorities for
its treatment, we are struck, not only with the multitude of remedies pro-
posed, but with their conflicting character ; and we find that, while one
practitioner extols his prescription as curing almost every case, another
pronounces it utterly valueless. In Paris, the subject seems to have attract-
ed much attention, and various papers have of late appeared in the different
journals, consisting of clinical observations on particular remedies. One of
these, by M. Martin Solon, on the use of nitrate of potass, we condensed for
the 5th number of the Scottish and North of England Gazette ; and we are
induced to return to the subject by the publication in the " Archives Gene-
rales de Medecine " of two papers by M. Monneret, — ^the one containing his
experience of the employment of sulphate of quinine, the other recording
the effects of tincture of colchicum, nitrate of potass, and blood-letting. A
valuable resume of the various remedies employed, in rheumatism has been
recently given by Dr Cowan in the Provincial Medical Journal, and from
these sources we have derived much assistance in drawing up the following
abstract. The various methods of treatment employed may be summarily
comprehended under five heads : 1st, Pure Antiphlogistic Treatment ; 2dy
Stimulant Sudorific ; Sd, Pure Stimulant ; 4th, Alterative ; 5th, Specific.
!«/, Pure Antiphlogistic Treatment. — The principal remedial means com-
prehended under this head are blood-letting and free purgation. Sydenliam
was a decided advocate for blood-letting, recommending ten ounces to be
abstracted every second day for four or five times. StoU, Sir John Pringle,
and Cullen, were also advocates for its employment. Dr Fowler has some
interesting observations on the effects of blood-letting in this disease. He
employed it in 41 out of 87 cases, with the following results : Cured, 3 ;
much relieved, 7 ; moderately relieved, 7 ; little relieved, 20 ; not bene-
fited, 4.
We find that Dr Fordyce was forced by experience to abandon blood-
letting ; and Herberden informs us that copious blood-lettings are unsuitable
to the majority of persons in rheumatism. The consequence has been, that
blood-letting fell into comparative desuetude, until its employment was re-
vived in modem times. Bouillaud is the most decided and uncompromising
advocate for its employment that has ever appeared, and has pushed it with a
vigour which, even in Edinburgh^ is startling. " The true specific," he ob-
serves^ ^ of acute articular rheumatism is blood-letting ; its quinine, if the
TREATMENT OF ACUTE RHEUMATISM. 75
expression is allowable, is the antiphlogistic system, and bleeding is the
prince of antiphlogistics."
The patient is on admission bled to sixteen or from that to twenty-four
ounces. Next day bled twice to sixteen ounces, and to amuse him between
the bleedings, cupping or leeching is practised, from twelve to twenty
ounces being thus abstracted locally. On the third day there is but one
bleeding and one cupping. On the fourth, unless cured, bled again. On
the fiffch, if the disease has not ceased, another blood-letting. The medium
quantity of blood taken from vigorous subjects in a violent case is from four
to five pounds. In some cases the abstraction of six, seven, or eight pounds
may be demanded.*
Dr Craigie, a decided advocate for blood-letting, states, '* that in order to
be beneficial, it ought to be performed early in the disease, and carried to a
considerable extent. * * * * It should be carried at first to 20, or 26,
or do ounces at once, if possible, and within twenty-four hours to as much
more."t
On the treatment of rheumatism by blood-letting Dr Alison remarks,
^that large and repeated blood-lettings in the beginning of rheumatism
increase the risk of metastasis to the heart." | Dr Hope, in recording the
experience of 200 cases, in reference to the "bleedingplan," writes as follows :§
" From ten to twenty years ago, this and the diaphoretic plan were in full
vogue, especially in Scotland ; and I saw them carried to their maximum
in the Edinburgh Infirmary during a residence of two years in that institu-
tion. Now, many cases, I admit, were promptly and effectually cured — even
annihilated at once — ^by the antiphlogistic plan ; but in many others, active
bleeding was carried to the very last ounce that could be drawn, yet the
enemy clung to the joints with a chronic grasp, and proceeded triumphant
in his crippling career. Add the pale emaciated frame and the slow con-
valescence, sometimes of two or three months' duration, and, too often, I
fear, the permanently shattered constitution," &c.
The following is the result of the experience of M. Monneret on the effect
of blood-letting in 19 cases of acute rheumatism. In all these cases the
blood-letting was practised with decision, — at least three general blood-let-
tings being prescribed during the first four days, with two cuppings from
the inflamed joints and the prsecordial region. The activity of the treat-
ment stopped a little short of that recommended by Bouillaud.
When the blood-letting was to prove beneficial, the pulse gradually fell,
the temperature of the skin diminishing at the same time. In other cases
the pulse would fall suddenly, while the temperature of the skin remained
above the natural standard ; in these, the pulse would again rise, and the
pains return with redoubled intensity, either in the joints already afiected
or in others.
When the pains are not relieved in the first four or five-days, we must
not expect that the blood-letting will prove a radical cure, and if had re-
course to after this, it appears to weaken the patient, and to produce a state
of anemia unfavourable to ultimate cure. In such cases M. Monneret has ^
observed ** bruits de soufile " in the large vessels and sometimes in the heart, '
abundant sweating, vigilance, fulness and frequency of the pulse. The
• See Nouvelles Recherches sur le Rheumatisme, Ac, par J. Bouillaud, p. 133.
t Craigie, Practice of Physic, vol. ii. p. 664.
X Cyc Prac. Med. Hist, of Med., part xxiv. p. 45.
§ Med. Gazette, vol. xix. p. 814.
76 TREATMENT OF ACUTE RHEVMATISAf.
pains, instead of disappearing^ flit from one joint to another, or obstinately
locate themselves in the ones first attacked.
These patients become tedious convalescents^ often remaining two or three
months in hospital.
Nor is the chlorotic state, with its gastralgic and neuralgic pains, the
only danger to which such patients are exposed ; but it seems to pave the
way for other diseases, induced doubtless by individual predisposition.
Sloughing over the sacrum, severe and fatal pneumonia, white swelling,'
chronic enlargement of the joints, have all occurred in patients largely bled.
The following are the conclusions at which M. Monneret arrives : —
1st, That moderate blood-letting may have a beneficial effect in the treat-
ment of acute rheumatism, if practised at the commencement of the disease,
especially during the first four days ; but that after this period it can only
weaken the patient, and retard the curative efforts of nature.
2d, That the cases where blood-letting was most beneficial were those in
which it was employed early, and carried to a considerable extent in a short
time,
3d, That although the beneficial effects of blood-letting so practised were
far from being constant, yet that they appeared more satis&ctory than those
cases in which smaller blood-lettings were resorted to at intervals through-
out the whole course of the disease.
Purgatives hold the place next in importance in the antiphlogiBtie
treatment, and they have been freely used in the treatment of rheumatism.
*^ Almost all practitioners," observes Dr Johnson, ** recommend cathartics
in acute rheumatbro, on the principle of detracting fiwm the general
circulation through the channel of the intestinal canal, thus reducing
vascular action."* On the same subject, Dr Barlow recommends, after
the use of the lancet, « to purge freely the stomach and boweWt So
convinced are some practitioners of the efficacy of purgatives, that they
attribute the benefit of certain remedies almost entirely to their cathartic
properties. Of colchicum, for example, Dr Eliotson states, that it " generally
does no good till it purges, and when once it purges the patient thoroughly
the disease usually gives way. J Dr Craigie also speaks of the « benefit
resulting from the use of guaiacum when it produces a loose state of the
bowels. I must also observe," he adds, " that I have, in the course of
administering tartrate of antimony for the treatment of rheumatic dis-
orders, several times observed, that after it had produced rather profuse
catharsis, the articular pains underwent remarkable abatement^ with
reduction of the pulse to the natural standard ; and they finally disap-
peared. Colchicum also very often purges smartly before it relieves the
articular pains."§ It will be seen that free and repeated evacuation oi
the bowels forms an important part of the plan of Dr Hope, which we
shall allude to more particukrly hereafter.
2d, The Stimtdant Sudorific Treatment. — One medicine of this class,
Dover's powder, is regarded almost as a specific in rheumatism ; but
whether it merits that character is rather doubtful. In the Edinburgh
school it was largely employed, chiefly perhaps owing to the strong re-
commendations of Professor Gregory, who regarded sweating as the
• Practical Researches on Gout and Rheumatism, by James Johnson, p. 270.
+ Cyclop, of Prac. Med., Art. Rheumatism.
X Lectures by Cooke, p., 740.
§ Craigie's Practice of Physic, voL ii.'p. 665,
TREATMENT OF ACUTE RHEUMATISM. 77
evacuation most to be Telied on after blood-letting. On this snbject Dr
Hope obserres, — ** Dr Gregory, the great advocate of this plan, premised
Tenesection and pniging till the pulse was lowered to 100, but * with these
appliances and means to boot,' I have seen patients stewed and parboiled
(if yon will excuse a culinary trope) for four, six, or eight weeks, and gain—
what ! — a more attenuated frame, chronic pains, and a confirmed suscepti-
bility of rheumatic attacks on the slightest variations of temperature*
This plan is now, I think, almost universally abandoned — ^by those at
least who keep pace with modem science."* The guaiacum, a remedy
introduced by Dr Dawson, and still occasionally employed, though usually
in chronic rheumatism, seems to owe any efiicacy it possesses to its
sudorific powers. Dr Graves is an advocate for its employment in chionic
cases where no symptoms of active local inflammation or general fever exist.
The formula he prescribes is as follows^ — and he regards it as acting by
increasing the secretion fix>m the skin, while at the same time it exercises
a stimulant action on the nervous and capillary systems : — ^'^ Powdered
bark, 3j> ; powdered guaiacum, 3j. ; cream of tartar, ^. ; flowers of sulphur,
§8S. ; powdered ginger, 3j- : — ^to be made into an electuary with the common
syrup used in hospitals.t The dose, a tea-spoonful three times a-day.
This^ however, will be too much for some cases and two little for others.
The object in every case should be to keep up a mild but steady action on
the bowels, and to procure a full alvine evacuation at least once a- day. If
the dose already mentioned does not answer this purpose, it must be in-
creased ; if the bowels are too free, it must be diminished."^ An electuary
nearly similar in composition was employed by Dr Law ; and Dr Mimk
states that he succeeded in curing three hundred cases by means of sul-
phur combined with carbonate of soda in the proportion of two drachms of
the latter to an ounce of the former. We have no doubt that, restricted to
the class of cases which Dr Graves has described, sudorifics vnll be foimd
beneficial; but in the acute variety of the disease, where spontaneous
sweating so often occurs, and proves any thing but salutary, this method
of treatment does not seem to be indicated. ** The sudorific plan of
treatment^" observes Dr Scudamore, ^not unfrequently disappoints our
expectations, so as to aggravate rather than relieve the symptoms. Even
when most successful, it is attended with the ill efiects of producing much
debility, and increasing the sensibility of the surface, so that for a con-
aderable time almost any degree of exposure is hazardous."§ And Dr
Barlow, in his very excellent article before quoted, observes : " The cure
of rheumatism by profuse perspiration has fidlen so much into disuse, that
it can be hardly necessary to notice it."
3d, Pure Stimulant Plan, — ^The exhibition of bark in the treatment of acute
rheumatism was introduced by Morton, but as it was opposed by Cullen,
it never obtained the confidence of the profession until after the publication of
Dr Haygarth. The following is his account of his method of prescribing it : —
* Medical Gazette, voL xix.
-f- The above formula is similaT to that of the empirical remedy for rheumatism,
termed the Chelsea Pensioner, the composition of which is as follows :.^Guaiac. 3i« ;
powdered rhubarb, 3ii-; cream of tartar, Ji.; flowers of sulphur, Jii.; one nutm^
finely powdered ; — ^the whole to be made into an electuary with one pound of clarified
honey. Two large spoonfuls to be taken night and morning.
J Clinical Medicine, p. 663.
§ Treatise, p. 542.
78 TREATMENT OF ACUTE RHEUMATISM.
*^ After the stomach and bowels have been sufficiently cleansed by anti-
mony, I have for many years begun to order the powder of Peruvian
bark in doses of gr, v. x. or xv. every two, three, or four hours ; and if this
quantity had a salutary effect, it was gradually increased to gr. xx. xxx.
or xl., with sedulous attention never to add more than what perfectly
agrees : it has generally been taken in milk, mint water, or the decoction
of bark." The results of this method of treatment, even on Br Haygarth's
own showing, do not appear to have been very encouraging, as we find that
he lost twelve cases out of a hundred and seventy ; and accordingly we are
not surprised that it fell into desuetude. Of late, however, an attempt has
been made to revive its employment, more especially among the Parisian
practitioners ; and we find a letter addressed by M. Briquet to the Academy
of Medicine of Paris, stating that lai^e doses of quinine were as successful
in the treatment of rheumatism as of ague. The researches of M.
Monneret bear upon this point, and we shall accordingly present an
abstract of them, as they appear to be at once the most recent and the
most accurate. In this valuable contribution, not only the effects pro-
duced by the medicine on the disease are recorded, but its influence on the
fleveral functions of the body ; we shall, however, restrict ourselves to the
former. The sulphate of quinine was given to 22 IndividuaLs (17 males, 5
females) ; 13 suffered from recent acute rheumatism, with fever, in several
joints ; 3 had rheumatism in several joints without fever ; 3 rheumatism
accompanied with fever in one joint ; in 1 the rheumatism was at once
articular and muscular ; in the remuning 2, muscular and accompanied
with neuralgic pains. The quinine was given in solution, with an excess
of acid, and therefore in the state of bisulphate. The medicine was in
every case persisted in for at least 10 days, sometimes for 14. One patient in
8 days took 29 grammes* of the salt, and after a cessation of some days,
during which he had been free from pain, he took, on account of the
return of the pain, in all 47 grammes ; a second took 67 grammes in 12
days ; a third 50 in 11. The smallest does was 2 grammes, the largest was
6. Of the 22 patients, 7 only were cured ; and among these, one was affected
with muscular and neuralgic rheumatism ; a second had articular rheuma-
tism of 15 days' standing, and was almost free from fever ; a third had
slight rheumatism with moderate fever ; in a fourth the pains were of 8 days'
standing, and the other local symptoms slight; so that, in fact, only 3 cases of
acute articular rheumatism appeared to yield to the remedy. In 1 6 other
cases, the pains were remarkably alleviated, usually on the second or third
day, more rarely on the first. In two-thirds of the cases, the pains ceased
so entirely that the cure was regarded as complete, the patient being able to
move his limbs without suffering, but they returned again, even although
the remedy was persisted in. The sulphate of quinine produced a curious
effect on the nervous system, which showed itself in two ways,— either in a
state of great excitement resembling that of intoxication, or a state of
collapse similar to that of typhus fever ; and it was remarked, that the
effect upon the articular pains seemed to correspond with the intensity of
the nervous affection. These experiments seem to be very accurate, and
certainly do not give much reason for confidence in tlie curative power of
quinine.
The late Dr Davis, the professor of Midwifery in the University of Lon-
don, recommends bleeding followed by an emetic, and in five or six hours
* The gramme equals Id round numbers \ drachm or 15.440 grains.
TREATMENT OF ACUTE RHEUMATISM. 79
an active purge ; after which he gives from a scruple to half a drachm of
powdered yellow bark every three or four hours. Under this treatment
the disease seldom exceeded a week,*
4ih, Calomel and Opium Plan, — The efficacy of opium in the treat-
ment of rheumatism has been long known. De Roches cured two cases
by its use alone^f and since then it has been recommended by several suc-
cessive authors. The practice, however, has met with much opposition.
Among those who condemn it are found the high names of Sydenham^
Cullen, and Armstrong. Dr Corrigan is an advocate for its employment,
and did not find it affect the cerebral functions. The mean quantity
which he exhibited was ten to twelve grains, but sometimes double this
dose was given. Professor Christison recommends frequent doses of Dover's
powder, which may relieve either by its opiate or sudorific properties.
Other narcotics have been given, especially the extract of aconite, or that of
belladonna. The calomel and opium plan, however, was first introduced by
Dr Robert Hamilton of Lyme Regisj;, who first bled his patient, and then
gave calomel and opium at suitable intervals, until the disease ceased, or
the specific effects of the medicine were produced. Of all the methods of
treatment this is perhaps the one in which the greatest confidence is placed,
and more recent improvements have consisted merely in modifications in
the method of prescribing it.
5^, Specific Remedies, — Under this head we class a few agents, regarding
the particular efi^ect of which on the constitution we are not sure, and
which we cannot therefore arrange under any of the foregoing heads. Isty
Colchicum is a remedy which has been lai^ely employed in the treatment
of rheumatism, and generally with the most lytneficial effects. It is highly
recommended by Dr Barlow, an author of great experience in these a^ec-
tions, and indeed, in combination with other remedies, is employed by almost
every practitioner of acknowledged reputation. It was with not a little
sorprise, then, that we observed that the author of the article Rheumatism
in the '^ Library of Medicine," states that colchicum has long held and
continues to hold an ill-deserved reputation as a remedy for acute rheu-
matism, and this upon the authority of eleven cases. On the same amount
of experience, the same author gives the authority of his name against the
use of calomel and opium. We shall give M. Monneret's observations upon
this drug, made with the tincture of the bulb of the colchicum. Most of the
patients took from 4 to 16 grammes in the 24 hours, — ^the one in one or two
doses, the other in four doses. M. M. always exceeded the usual dose. He
never commenced with less than 4 grammes, and he remarked that while the
doses could be very rapidly increased, the large ones could not be safely con-
tinued long. Some patients took it for 9, 10, or 13 days, but with an interval
of 2 or 8 days. 21 patients were treated by this medicine, and, in all these
cases, it was continued until M. M. was convinced that it was producing no
effect. M. M. does not consider it necessary to state minutely the peculiar-
ities of the cases, *^ because in not a single one was the use of the tincture
of colchicum followed by. an evident and durable cure." But when we
come to examine further, we find that 8 patients, that is to say, more than
a third, recovered while taking it, and that all that our author means to
assert is, that it cured them by means of its . powerful purgative effect, and
not by any latent specific virtue which it might possess. This opinion we
• Lancet, 1841. t Medical and Surgical Journal, vol. i. p. 154,
{ Medical Commentaries, 1783.
80 TREATMENT OF ACUTE RHEUMATISM.
have already shown to be held by many British practitioners, who, in order
to ensore the pui^tive effect, exhibit the colchicum in combination with
saline aperients. *^ The two best internal medicines," observes Dr filliotson,
** are without doubt colchicum and mercury. Colchicum here, as in the case
of the gout, generally does no good till it purges, and when it once purges
the patient thoroughly, the disease usually gives way. It should be given
in Uie same way as in gout, that is to say, with magnesia, that it may
produce its efifect as speedily as possible. As soon as it purges it is right to
desist ; and also as soon as its effect ceases. If you give a dose of hydro-
cyanic acid with the colchicum, it sits better on the stomach ; you may
exhibit one, two, or three minims."*
Dr Hughes gave a pill of opium and antimony at night, and half a drachm
of the colchicum wine, with a drachm of the sulphate of magnesia, three or
four times a-day, until copious, liquid, yellow evacuations were produced,
when, if the pain was abated, bark and soda were prescribed. Mr Wigan gives
8 gndns of powdered colchicum root every hour, until vomiting, purging, or
profuse perspiration occurs. The minimum quantity is 5 doses, the maxi-
mum 14, the average 8 or 10.
2. Nitre. — ^This remedy was introduced in 1764 by Dr Brocklesby. A
full account of it was given in the 5th Number of the Scottish and North
of England Gazette, in which the observations of M. Martin Solon were
condensed. His observations were made on 38 patients : of these, 20 were
cured &om the Sd to the 7th day ; 11 from the 9th to the 10th ; 2 &om
the 11th to the 15th. In 27 of these cases the malady ceased gradually
after the exhibition of the remedy ; in 6, other articulations were attacked.
In 9 cases, where bleeding was also employed, the convalescence seemed to
be rendered more tedious, and two of these patients had relapses. The
usual dose was 80 grammes in the 24 hours, and in ten cases it was carried
as high as 00. In 9 cases it produced nausea, vomiting, and purging, but
this was removed by adding syrup of poppy to the lemonade in which it
was usually given. Dr Brocklesby gave 18 drachms in the 24 hours ; Mr
White, 12 drachms. Mr Home recommends the following mixture : —
R. nitratis potassfe, 553. ; tart antimonii, gr. ii. ; spt. stheris nitrici, §i. ;
aque fontis, §xii. : misce. A wine-glassful three times a-day .t
M. Monneret tried nitre in 8 cases, in all of which the rheumatism was
recent and intense. One of the patients suffered from meningitis, and an-
other from pneumonia; the dose given was fi-om 8 to 30 grammes. M.
Monneret could not observe any benefit result from its employment. He
never gave more than 30 drachms. The articular pains, the fever, the
state of the pulse, and the urine, were unaffected by its employment, nor
did the latter exceed the quantity of fluid swallowed. In all these cases
the remedy had to be changed in order to prevent serious resulta.
3. Iodine. — Dr Cowan gave the hydriodate of potass in 52 cases, in
average doses of five grains three times a-day. In no instance was either
bleeding or leeching prescribed. The following is his opinion of its powers :
** The action of iodine in rheumatism is, on the whole, satisfactory ; in
many cases it may be regarded as heroic, while in others not a priori dis-
tinguishable, almost negative. After examining the experience of different
observers, we are inclined to suspect that we have often erred by the small-
ness of the dose, and think it probable that the quantity should in some
• Letters by Cooke, p. 740. t Lancet, Dec. 10, 1842.
TREATMENT OF ACUTE RHEUMATISM. 81
cases be increased to the point of tolerance, the rheumatic element^ so to
speak, varying in amount and intensity in different individuals."
" In the I^cet for Nov. 16, 1839, Mr Henry Rees says, * In all cases
of acute rheumatism the diet should be strictly regulated ; avoid rigidly
beer, wine, spirits, and animal food. Milk, beef- tea, butter, eggs, fish, &c.,
are all pernicious. His theory is, that the disease depends on an excess of
nitrogen. In very urgent cases bleeding and mercury may be necessary ;
but he regards the hydriodate of potass as certain an antidote to the rheu-
matic diathesis as mercury is to that of syphilis. Its combination with
liquor potasse acts, he says, like a charm in rheumatic iritis."
"In a very obstinate case, characterized by severe pains, relieved by
heat, and unaccompanied by much swelling, occurring in the practice of
Mr John Brady of London, the following means proved very successful : —
Compound extract of sarsaparilla, six drachma ; iodine, half a grain ;
hydriodate of potash, half a drachm ; boiling water, six ounces : mix. A
fourth part three times a- day, with one of the subjoined pills. Hydro-
chlorate of morphia, one grain ; disulphate of quinine, nine grains ; blue
pill, ten grains ; rhubarb j)ill, twelve grains. Divide into twelve pills."
Dr Graves recommends hydriodate of potass in lumbago.
" I first became acquainted with the remarkable efficacy of this medicine
in lumbago and sciatica, under the following circumstances. In the mem-
orably wet month of July 1839, 1 Was called out of bed at midnight to visit
a lady in the country, and the vehicle sent to convey me was a hack, covered
car. The cushions wfere Very damp, Aad I had not proceeded half a mile
before I was attacked with lumbago so severe that I could scarcely walk
when I arrived at my patient'^ residence. Next morning I was better,
having perspired much during the night ; but still the pain was troublesome^
and as the season continued unusually cold and wet (indeed it scarcely ever
stopped raining from the 8th of July 1839 to the 19th of February 1840),
and as my duties exposed mc much to the weather, and prevented me from
giving myself the necessary rest, my lumbago continued to increase again,
and in about a month, the gluteal and sciatic nerVes of the left side became
engaged ; I noted particulatlyj thtit the pain spread very gradually down-
wards from the lumbar region, so that it took a week or ten days to arrive
at the ham, and a still longer time at the ankle. I was then quite lame of
the left leg, suffered much from {>ain in bed, and had become so helpless,
that I had to get my servant to draw on my stockings. During all this time
my general health was perfect, appetite good, digestion regular, and no
deviation of the urine from the natural appearance. I mention this because
several of my medical friends advised me to take antibilious Aperients, an
advice founded on Abemethy's doctrine, that many local affections proceed
from stomach derangement. I was at last forced to try sdmethltig for my
relief, and had myself cupped, and tried the w^arm douche and Dover's
powder, but without any good effects. I began now to fear that I should
be forced to give up all prdfessioiial business, and confine myself to the
house for many weeks, in order to go through a mercurial course^ combined
with proper topical applications, when happening to meet Mr Ferguson of
Kildare Street, he reconmiended me to try hydriodate of potash, of which
he was good enough to send me a drachm dissolved in a pint of decoction of
sarsaparilla. I took a quarter of this daily, and may literally apply here the
common phrase, that I felt each dose do me good ; in truth, the benefit I
derived was perceptible hourly, and was so rapid, that in four days all traces
of the lumbago were gone, and my lameness had quite ceased. I did not
82 TBEATMENT OF ACUTE RHEUMATISM.
take more than one bottle, t. e. one drachm of the hydriodate ; but the good
effect continued after I had ceased taking it, and in less than a week I was
perfectly well. Subsequent experience enables me to recommend this
medicine strongly in sub-acute and chronic lumbago and sciatica.*
" It is right to observe, that the remedy had in my own person to work
against various disadvantages, for I neither relaxed froni my labours nor
refrained from eating and drinking as usual. This is only another exaxx^le
of the many I have met, which prove how injudicious it often is to seek
the cure of local inflammations by means of lowering the whole system."t
We shall lastly present our readers with a summary of the method of
treatment adopted by several practitioners^ and leave them to judge for
themselves as to the plans proposed.
Mr Baynton of Bristol orders all mufflings off his patients, and ad-
mits a free circulation of cool air through the chamber by open windows.
Absolute quiescence is enjoined, the most rigid abstinence is to be observed,
and no medicine is given except gentle laxatives ; the shower bath is to be
used during convalescence.
" The late Dr Hope, after six years' experience upon 200 cases^ gives de-
cided preference to the following plan : — After one or even two fiill bleed-
ings in the robust, he gave seven to ten grains of calomel, with one or two
of opium at night, a draught with fifteen to twenty minims of colchicum
wine, and five grains of Dover's powder in saline mixture, three times a-day.
It was seldom necessary to repeat the calomel moi'^.than from two to four
times, ailer which he continued the opium at night, with the colchicum
draught and a senna laxative every morning. The patient was almost always
well in a week, and able to commence his work in seven to ten days after the
pains had ceased. Ftyalism was avoided unless the heart was involved.
**" In chronic cases he gave five grains of calomel, and one of opium, at
night, for five or six times, with the senna and colchicum draught as before.
Local depletion with some form of counter-irritation wei*e usually employed.
** Dr Macleod advises bleeding, abstracting from twelve to thirty ounces
during the first week, giving three to five grains of calomel at night, and a
senna purge in the morning. Opium to the extent of two grains in the
twenty-four hours is often useful, and the guaiacum is recommended as
the best after-treatment. In lumbago Dr M. thinks well of a brisk calomel
pui^e once or twice a- week as above, and considers half a drachm to two
drachms of the compound tincture of guaiacum three times a-day, with a
grain of opium at night, the best plan."
*^ Against rheumatic headach Dr Johnson has found no treatment so
successful as the following : — Eight grains of Dover's powder and two of
calomel at bed-time, on alternate nights, for two or three times, followed by
a third part of the following mixture the next morning, to be repeated in
• " My friend Dr Osbrey, in an exceedingly useful paper on the * Usea of some
of the Combinations of Iodine,* published in the twenty-first volume of the Dublin
Medical Journal, makes the following remarks, the importance of which I fully
admit : * The readers of this journal are aware that Dr Graves has strongly recom-
mended the use of iodide of potassium in lumbago, for which I have found it an
excellent remedy. There is one form, however, of rheumatism of the muscles of the
back and loins, in which it should be used with caution ; it is that which is attended
with dyspeptic symptoms, such as flatulency, diarrhcsa, and irritability of the
stomach ; these symptoms, in my opinion, should be first relieved before having
recourse to iodine. In sciatica I have also found that remedy useful.* "
t Clinical Medicine, p. 864.
GROWTH OF NEW BONE. 83
two hours, if necessary : — Infusion of rhubarb, three ounces ; tartrate of
soda, three drachms ; powder of rhubarb, half a drachm ; tincture of senna,
half an ounce ; wme of colchicum, a drachm and a half : mix.
" The same observer remarks (Medico-Chirurgical Review, April 1838),
that many of the most stubborn cases will yield to a course of blue or
Plummer's pill, taken at bed-time, and foUowed by a warm saline and
oolchicum draught in the morning. Flannel clothing, and an occasional
warm bath, are valuable adjuvants."
" In the acute stage Dr Graves principally relies on bleeding, with large
doses of tartar emetic and nitre ; and in less urgent cases, particularly if
complicated with bronchitis, he has derived much benefit from the follow-
ing mixture :~^Almond emulsion, eight ounces ; vinegar of colchicum, half
an ounce ; acetate of morphia, one grain ; nitrate of potash, half a drachm :
mix. Half an ounce every hour or every two hours."
MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN.
Qrwoth of New Bone on the Internal Surface of the Cranium in Pregnant
Females.
M. Ddcrest has published a memoir on this subject, founded upon 231
observations, which- he has made in women who haver died in or shortly
after childbed. He commences by detailing 10 cases in which the osteo-
phyte may be traced through its various pliases. In its earliest stage
nothing attracts attention but red spots, which occupy one, two, or more of
the depressions on the cranium corresponding to the cerebral convolutions.
When these patches are scraped they are found to consist of layers of a
reddish matter on which there is as yet no hard substance. The patches, at
first isolated, nnite, enlarge, and constitute on either side of the cranium
(for they are developed symmetrically) extensive layers, which ultimately
join in the median line. A few patches have been found at the base of the
cfanium ; but the frontal region is that on which they are most commonly
observed. As these patches increase in extent, they acquire greater firmness,
and approach more and more to bony hardness. Nevertheless, their consis-
tence is not always in proportion to their extent ; for they are sometimes
found to cover the whole inner surface of the skullcap, and yet to be cut
as easily as cartilage, while at other times, when in much smaller patches,
they are with difficulty marked by the edge of the scalpel. When the
osteophyte is in its rudimentary state, the only trace of tissue which can
be perceived is a tortuous vascular network ; when somewhat further ad-
vanced, it is composed of two distinct layers, the one of compact tissue in
connexion with the dura mater, and the other of spongy texture applied on
the inner table of the skullcap. After describing the new product, the
author passes to an examination of the adjoining structures — the dura mater
and the cranial bones ; in the foimer he has never found any variation from
the natural condition, but in the latter he has constantly observed increased
vascularity in the parts adjoining the new growth. The osteophyte does
not appear to give rise to any inconvenience, nor to any symptoms by which
we could pronounce on presence during life. Out of 231 cases of women
who had died in childbed, M. Ducrest has observed the " exostose epiphy-
wire" in 91 instances ; the number of pregnancies does not appear to pre-
dispose to the development of this new product ; and M. D. sums up his
observations with the four following conclusions : — 1. There is found in the
cranium of women who have died in childbed a production at first cartila-
84 GROWTH OF NEW BONE.
ginous, but which ultimately becomes osseous ; 2. The craniam and dura
mater in connexion with the osteophyte present no special lesion ; 3. It is
most commonly met wuth in young females ; 4. Its presence does not give
rise to any peculiar symptoms. — Memoires de PAcadtmie Medicale d'Observa-
tion, 1844, tome ii. p. 381.
Several of the statements advanced as facts by M. Ducrest are totally at
variance with the observations both of Professor Rokitanski and our own.
We imagine M. D. to be perfectly ignorant of the extreme attention paid
to this subject for many years past by Prof. R. ; for M. D. tells us that it
is " une chose fort peu connue" and his account is not to be compared either
for accuracy or completeness with that of Rokitanski published in the
Oesterr Med, Jahrl for 1838— six years ago. We have had opportunities of
assisting at several of Prof. R.'s investigations, and it has always appeared
to us that the new bone grows on the elevations of the inner table of the
cranium, not, as stated by M. Ducrest, on the depressions : we do not, how-
ever, agree with Rokitanski in thinking that its growth is confined to the
elevations because the brain exerts greater pressure on the depressions than
on the elevations, for we should suppose this to be equal on all points
within the cranium. It is most frequently, also, very thick and fully
developed along the course of the large vessels, for example, along the track
of the arteria meningea media and the longitudinal sinus. Professor
Rokitanski observed the new product in more than the half of 1500 cases
of puerperal females, whose bodies he examined in the space of ten years ;
and as the greater number, if not all of them, had died of some variety of
the affection termed " puerperal fever," he concluded that it had some con-
nexion with that disease ; but later investigation — ^in pregnant women, for
example, who had died of the most rapid form of Asiatic cholera, and in
whom he found the osteophyte — caused him to avow the incorrectness of
his first supposition. We have ourselves seen it where the females have
died from hemorrhage, convulsions, rupture of the uterus, and phthisis ; it
has been seen previous to the sixth month of pregnancy, and so late as three
months after delivery ; and does not appear to be developed in cases of extra-
uterine pregnancy, moles, or polypi. In the opinion of Rokitanski, it is
in some way connected with the cessation of the menstrual discharge. His
theory is founded on the statement of Retzius, that the menstrual dischax^ge
contains free phosphoric and lactic acids ; and he thinks that the phosphoric
acid thus retained in the system may be periodically employed in the pro-
duction of new bone, and that therefore the osteophyte ought not to be
found in those females who have menstruated or suffered much from
acidity of the primse vise during pregnancy, as, in either of these cases, the
acid is eliminated from the system. This is an hypothesis, however, which
will require to be tested by the observation of years. Prof. R. endeavours
to support this theory by the fact, that once in a chlorotic virgin he ob-
served hyperostosis of the cranium ; in this case there was also deposit of
phosphate of lime on the mitral valve. In general this hyperostosis is pro-
ductive of no bad consequence ; but a very singular case— one Highly inter-
esting in a physiological point of view — is recorded, whei'e the bony growth
encroached upon several of the foramina at the base of the cranium through
which the nerves pass out, and induced a series of remarkable nervous
symptoms, ending in the death of the patient.* The exostose epiphyaaire
has been found on all the bones of the cranium and face, but never on those
of the trunk, pelvis, or extremities.
* Hufeland's Journal der Pract Halkunde^ Juni 1840, 8. 61.
PREGNANCY WITH IMPERFORATE AND BILOCULAR UTERUS. 85
Pregnancy with Imperforate and Bilocular Uterus.
Dr Lumpe of Vienna was called to attend a female, st. 30, in her first
confinement. An examination per vaginam detected that that canal ap-
peared to he partially closed up, at the distance of two inches from the
external part^ hy a structure composed of interlaced fibres of different
thickness ; ahout an inch and a half above this, on the posterior wall,
the vagma seemed to end 'm& cul de sac. No vaginal portion of a uterus
could be discovered. The urethra was so wide that the finger could be
easily introduced into it, and the foetal head felt pressing into the pelvis.
When the first pains occurred, the portion of the posterior vagin^ wall
beyond the septum was perceived to widen, so that the point of the finger
could be farther advanced, and an incision was just al^out to be made into
this part, when a violent uterine contraction supervened, two or three
ounces of blood were effused, and soon thereafter the liquor anmii escaped.
On examination, there was discovered a rough transverse opening, high and
posterior, which rapidly widened, and through which a living child was
soon after born. A few days thereafter the patient was seized with metro-
peritonitis, and died in four days. On dissection there was found violent
peritonitis with much exudation ; the cavity of the uterus was divided
vertically by a partition wall, down to the internal orifice of the cervix,
into two portions ; the left had been pregnant, the right division was
widened, increased in volume, vascular, and coated with a fine membranous
exudation (the decidua 1) The cervix and orifice were natural. — Oesterr
Mediz Wochenschrift^ No. 37, 1843.
The above detail would lead us to suppose that a rupture took place
somewhere, were it not that the os and cervix uteri are said to have
been natural : the case is certainly not clearly recorded. The practice of
making an os uteri by incision when one does not naturally exist must
always be attended with much danger, as there is no possibility of prevent-
ing the incision being prolonged by laceration. The practice has however
been in a few cases attended with a successful result. It is rarely indeed
necessary ; for although, previous to the supervention of labour, experienced
accoucheurs have been unable to discover any trace of an os uteri, the
parturient efforts do not last long before the aperture appears and dilates
with tolerable ease. Another point of interest in the preceding case is
the circumstance that a decidua existed in the unoccupied half of tlie
uterus ; this is an additional proof that the decidua is not an adventitious
membrane caused only by local irritation, as some would have us believe,
but a veritable hypertrophy of the mucous lining of the uterus. We
know that during pregnancy the uterus as a whole grows, that its nerves
and vessels individually enlarge, and why not its mucou9 membrane 1
FORENSIC MEDICINE AND MEDICAL POLICE.
Term of Pregnancy exceeded by Four Weeks.
A PREGNANT womau, who had already borne three children, was attended
by Dr Hayn of Konigsberg for " gastro-nervous fever." The affection was
so severe that premature labour was threatened. Dr H. made an examina-
tion per vaginamy and felt satisfied, as well from this as from the woman's
account, and her other symptoms, that the natural term of her utero-gesta-
tion would expire about the 23d of May 1841. The patient recovered from
86 TERM OF PREGNANCY EXCEEDED.
her fever, and at the aboye-mentioned date was seized with weak Ubour
pamsy copious mucous secretion from the vagina, and remarkable sinking
of the uterus into the pelvis. After three days the pains wore away ; and
four weeks thereafter the woman was with difficulty delivered of an unusu>
ally large child. — Ciuper's Wochenschrift^ No. 47, 1843. — The question of
protracted gestation has given rise to considerable discussion in courts of
law, and we have thought fit to extract the foregoing case ; for, in the words
of Mr Taylor, in his excellent Manual of Medical Jurisprudence, ^ it is only
by the accumulation of well-ascertained facts, from all authentic sources,
that medical knowledge can be made available to the purposes of law.'*
We should suppose that no one at the present day doubts of the occasional
protraction of gestation for two, three, or even four weeks. It would be
much better that, in reckoning the duration of pregnancy, it should be
counted by months of 28 days only ; for such a month is a determinate definite
period, not liable like the calendar month to vary from 28 to 31 days. Of
course the objection urged to all such cases as the above is, that " there
has been some error in the calculation.'* The remarks of the author whom
we have already quoted on this subject are so excellent that we shall extract
them for the benefit of our readers : — <' It is impossible to admit that these
cases depend on some mistake being made in the calculation of the period,
since this calculation was founded upon the same principles as those adopted
in cases of ordinary pregnancy. Hence, if there were a mistake in the one,
there would be in the other, — if an error in the exception, there would be
m the rule. Either pregnancy is wrongly calculated at the thirty-eighth
and fortieth week, or it is rightly calculated to extend occasionally to the
forty-fourth week,"
Toxicohgicdl Effects of the Sulphate of Quinine^ hy M, Monneret,
The author states that, when the sulphate of quinine has been given for
a long period and in large doses, it produces certain poisonous efi^ects
characterized by three distinct orders of phenomena, — 1st, nervous derange-
ment ; 2dly, gastro-intestinal irritation ; and, 3dly, a state which he terms
** typhique" on account of its resemblance to typhoid fever. 1st, The nervous
derangements manifest themselves in half or a quarter of an hour after the
exhibition of the dose ; there is noise in the ears, almost invariably vertigo,
and sometimes stupor, but no headach, how severe soever the other symp-
toms may be ; vision becomes confused, and objects are perceived as if
through a mist. Amaurosis was met with in four instances ; in one of these
the patient had taken 15 grammes * of the sulphate ; a female who had
taken the same quantity in three days, lost her sight entirely for five days.
** Vivreese quinique" chinic intoTUcation, shows itself of two kinds; either as
a state of great excitement, or of collapse, the latter being the most common.
In the former variety the patients are agitated, attempt to get out of bed,
speak in an agitated, tremulous, indistinct voice, and, if they have been
previously rheumatic, declare that their pain has entirely left them ; in the
latter form there is exhaustion, stupor, feebleness, a certain slowness of in-
tellect and memory, and disinclination for food ; at the same time the eye is
** teme," " abattu," and glassy, the eyelids half open, the countenance much
disturbed, and the noise in the ears and vertigo intend. — 2dly, Qastro intest-
inal symptoms. After the nervous symptoms have manifested themselves,
• The gramme is equal to 15*434 English ttoj grains ; say in round numbers
ltS\ grains.
TOXICOLOGICAL EFFECTS OF THE SULPHATE OF QUININE. 87
ihere is a disagreeable, sometimes a painful sensation opposite the inferior
extremity of the sternum, occasionally also symptoms of irritation of the
oesophagus and cardia. Of twenty-two individuals affected with rheu^
siatism to whom the quinine was administered, six suffered from gastro*
intestinal inflammation characterized by the following signs: — Tonguo
red, dry, and rough ; this organ as well as the lining membrane of the
mouth was spotted with patches of diphtherite, which in one case ex-
tended into the pharynx ; extreme thirst ; frequent bilious vomiting ;
edic pains and tension through the whole abdomen ; constipation followed
by diarrhoea; in one case the numerous stools c(»isisted almost entirely
of pure blood mixed with &lse membrane ; in another the inflammation
was moderate in the stomach and small intestines, but severe in the large ;
there was violent pain along the course of the colon, frequent serous eva«
cuations, with tenesmus and heat at the anus. The gastro-enteritis lasted
for a considerable period, and was liable to return. It was very severe in
three cases, in one of which the fli'st dose of quinine sufficed to cause severe
intermitting abdominal pain, not increased on pressure, but which was
quickly followed by the symptoms above described ; in the other two
cases the symptoms were not developed until the quinine had been taken
in large doses for ten or eleven days. — 3dly, The typhoid symptoms are de-
veloped shortly after the others ; the countenance expresses stupor and dul*
ness. In two cases only the typhoid appeared unaccompanied by any other
phenomena. In six cases it supervened on gastro-enteritis ; in Ave of these
cases it was accompanied with great prostration and repeated epistaxis ; in
the sixth — ^that in which the irritation predominated especially in the laige
intestine — the typhoid symptoms were slight ; but in all the intellect was
weakened and slow ; in one patient there was hemorrhage from the urinary
passages, and small ecchymosis on the abdomen ; in another menstruation
appeared copiously twelve days before its proper period. — 4thly, Effects
en other functions* One patient suffered &om extreme itching of the
skin, without any appreciable eruption ; in a second, there was disagree-
able pricking in the soles of the feet ; in a third, an eruption like rubeola,
bat without any of the other phenomena of that disease ; in a fourth, true
scarlatina, with its local characters only ; in a fifth, papulae on the abdo-
men, which quickly disappeared ; in a sixth, papulae mixed with petechiae.
The urinaiy secretion was not increased, but sulphate of quinine could be
detected in it twenty minutes after the exhibition of the salt, and could still
be discovered in that secretion long after the poisonous symptoms had dis-
appeared. — Journal de MedecinCf Nos.for January and February 1844. — ^AU
of the patients alluded to in the foregoing detail were under treatment for
rheumatism ; the quinine was generally given in solution with a slight ex-
cess of add, in the dose of two grammes a-day, gradually increased to six.
One patient took twenty-nine grammes in eight days, a second fifty-seven
in. twelve days, and a third fifty in eleven days.
Part IV.— MEDICAL MEMORANDA.
THE LATE DR ANDREW MOIR.
It is with deep regret that we announce the death, on the 6th inst., of the
late Dr Andrew Moib, Lecturer on Anatomy in King's College Medical
88 THE LATE DR ANDREW MOIR.
School. Cut ofiF at the early age of 38 years, from contagious fever, caught
in the discharge of his profession, his death has deprived Aberdeen of a
townsman of whom she had reason to be proud, and her medical school of
one of its most efficient teachers. What adds to the melancholy nature of
the event is, that Dr Moir has left an aged mother, a widow, and three very
young children (the last of whom was bom two days after his decease),
totally unprovided for, without relatives, and destitute even of temporary
supplies.
Unknown to many of his fellow-citizens, because occupying no prominent
place in the eye of the public, Dr Moir nevertheless possessed talents of a
very high order ; and, what is more, he rendered services to the community,
and made sacrifices in the performance of them, which entitle his memory
to lasting honour, and his bereaved family to the warm sympathy of the
benevolent.
We regret that we are precluded, by want of space, from giving an outline
of his eventful history. Suffice it to say, that, within a short time, Mr
Moir completely established his reputation as a teacher, secured himself
in the esteem and patronage of the medical students, whom he drew in great
numbers annually to his class, and commanded the confidence of his seniors
in the profession. For eleven years, during which he was a private lecturer,
he taught anatomy under very disadvantageous circumstances, encountering
difficulties such as few but himself could have borne up under. Twice his
property was burnt and destroyed by the populace ; and the circumstances
attending the last popular outbreak, in 1882, the numbers and exasperation
of the people, the personal injuries he received, and the narrow escape he
made with his life, the calling out of the military, and the sensation it ex-
cited all over the town, will be fresh in the memory of many of our readers.
It would require the imagination of Dickens to do justice to the scene which
was then exhibited ; and, in truth, it would form a fine subject for his pen.
In 1839, the University School, then under the joint patronage of King's
and Marischal Colleges, was broken up, and each college set up a medical
school of its own. Mr Moir was chosen by the professors of King's College
their lecturer on anatomy ; and such was the sense they entertained of
his distinguished merits as a teacher, that they unanimously conferred upon
him, in 1840, the honorary degree of M. D.
The situation of Dr Moir's bereaved and destitiite family has a strong
claim on the sympathy of a generous public — ^a claim which, we are sure,
will not be disregarded. Indeed, we have evidence that active exertions are
making among his late professional friends, in Order to secure some provision
for them ; and that a general feeling, which we al-e anxious to foster, prevails
among the whole community to come forward in their behalf. Mr Robert
Dyce, advocate^ has, we are glad to learn, kindly consented to act as trea-
surer ; and he, or any of the medical gentlemen in town, will be happy to
receive the contributions of the benevolent.
It speaks strongly for the estimation in which the late Dr Moir was held,
that his remains were, on Monday last, followed to the grave, from the
Medical Society's hall, by the whole faculty, the medical students, the
medical professors and lecturers, both of Kkig's and Marischal Colleges,
and a lai^e body of private friends. — Aberdeen Journal^ February 14, 1844.
Printed bjr OUvfer & Boyd, Tweeddale Court, High Street, Edinburgh.
THE
NORTHERN
JOURNAL OF MEDICINE.
No. II.— JUNE 1844.
Part I.— ORiaiNAL ARTICLES.
Condyloma, a Primary Form of Venereal Disease identical
with Sibhens. By David Skae, M. D., F. R. C. S., Lecturer on
Anatomy, Surgeon to the Lock Hospital, Eye Dispensary, &c.
The flat and whitish elevations of the skin occurring on the verge
of the anus, on the perinasum, labia, or scrotum, and occasion-
ally on the thighs, or even in the axillae, and known under the
names of condylomata, tubercules muqueuses, &c., are in this
country generally ascribed to one of two causes. By some of our
most distinguished writers they are ascribed to inattention to
cleanliness in persons labouring under chronic discharges from
the genital organs. " These soft excrescences," says Dr Adams,
" arise sometimes in consequence of a discharge from the rectum
stimulating the neighbouring parts to ulceration. If such ulcers
are prevented from healing by the discharge continuing, or by
the friction of the parts, they must either ulcerate deeper and
wider, or the cuticle will sefld out processes to defend them.
These, on accoimt of the pressure they receive, grow in various
shapes, from which they have acquired their names.
" They will arise from a venereal origin in two ways. If a
secondary ulcer is seated in these parts, that ulcer, having no
power of healing itself, will take the character above described
from the nature of the parts. Sometimes, also, the matter of
gonorrhoea, by falling from the vagina along the perinaBum,
will produce ulceration, and the same consequences follow."*
« Admi on Hwbid Vovww, London^ 1807, ^ 179.
M
90 CONDYLOMA OR SIBBENS,
By others these condylomata are believed to be identical with
the scaly eruption which follows the true syphihtic sore, modified
in its appearance by the situation where it occurs. " When the
eruption," says Mr Carmichael,* speaking of the scaly syphi-
litic eruption, '* affects a skin which is opposed by another skin,
as between the nates, or between the scrotum and thigh, or
under the arms, or between the thighs, it is not scaly ; but the
skin becomes elevated into a moist, soft, flat, or somewhat con-
vex surface, which discharges a whitish matter. These are the
appearances which, I believe, in authors are termed condylomata,
fici, cristaD, mariscaB, &c. — denominations applied according to
their figure, or perhaps the fancy of the practitioner."
The opinion last cited is the one generally adopted by most of
our systematic writers on surgery regarding condylomata. By
M. Ricord and other continental writers they are arranged with
the secondary symptoms of syphilis. With pretty extensive
opportunities of observation in the Lock Hospital of this city, I
myself entertained the opinion for some years, that condyloma
was a consequence of filth and protracted gonorrhoeal or leucor-
rhoeal discharges ; nor is it surprising, for in a great number of
the cases — and they always constitute a large proportion of those
under treatment in the hospital — these condylomatous excres-
cences are seen in females who either have had, or are at the
time labouriflg under, chronic discharges from the uterus or
vagina.
In 1835, the late Dr Wallace of Dublin, in a series of clinical
lectures published In the Lancet, announced some new views
regarding the nature of these excrescences, or, to speak more
correctly, of this peculiar eruption. He was the first to point
out that it was almost invariably associated with a certain group
of symptoms of a peculiar and definite character. Of this group
the most remarkable pointed out by him was a peculiar morbid
state of the mucous surface of the lips, cheeks, palatine arches,
or tonsils. This morbid state consisted in peculiar white ele-
vated patches, having the appearance of parts touched with
nitrate of silver, or coated with milk ; these patches are more
or less elevated, irregular in form, and presenting occasionally
superficial ulcerations on their surface.
Dr Wallace further pointed out that these spots were asso-
ciated with, or rather preceded in general by, an exanthematous
* Carmichael on the Venereal Disease, &c., Dublin, 18U, p. 42.
A PRIMARY FORM OF VENBREAL DISEASE. 91
eruption of a mottled appearance, and of a red or brownish
colour, sometimes preceded hj vesication or scaliness, but never
bj pustules ; sometimes elevated and approaching in appearance,
in Yarious parts of the skin, to the mucous tubercles or condylo-
mata commonly observed on the genital organs, and producing
in the folds of the skin (as between the fingers, &c.) those linear
ulcerations called rhagades; under the nails, onyxis ; in the head,
&c., falling of the hair.
From these and other facts, he inferred that condylomata, and
the peculiar patches on the mucous membrane of the mouth and
fEtuces, were parts of the same exanthema, modified in appear-
ance by the tissue where they appeared, and constituting a group
of " constitutional," to use his own words, " or secondary vene-
real symptoms, of which condylomata, rhagades, onyxis, falling of
the hair, and a pecuUar state of disease of the mucous membrane
of the mouth, are the most remarkable." To this group of
symptoms he gave the name of '' exanthematic primary sy-
philis."
He further asserted, that it could be propagated by inocu-
lation and by simple contagion, and that it did not differ in its
origin from syphilis, but resulted from a peculiar modification of
the syphilitic virus from its having passed through the system.
" The exanthematous group of venereal eruptions," he says,
" are produced by secondary matter, or by matter originally
derived from the common pustular primary sore, and snhsequently
modified by passing through the system."*
After the extensive series of experiments performed by M.
Ricord with the matter of secondary syphilitic sores and erup-
tions, and the verification of his results in the hands of others,
it can scarcely b^ doubted that it is impossible to produce a
venereal sore of any kind, much less the peculiar group of symp-
toms described by Dr Wallace, by inoculation with matter so
modified. I do not say that it is impossible to reproduce condy-
loma by inoculation from the matter of a condyloma^ but that
there is no evidence that condyloma can be produced by inocu-
lation with the matter derived from an undoubted secondary
syphilitic ulcer or eruption.
This conclusion, while it appears to overturn the ingenious
theory of Dr Wallace, leads, if the facts stated by him regard-
ing the symptoms of this affection are correct, to the adoption of
« Lsneet, 1835.6, vol. il. p. 198,
92 CONDYLOMA OR SIBBENS,
another view of the subject, now becoming prevalent in some
parts of the Continent, namely, that condyloma is a primary form
of venereal disease, distinct from either gonorrhoea or syphilis,
but equally definite and specific in its character with the latter
affection. This opinion is now entertained in some of the prin-
cipal hospitals of Eussia, Austria, and Germany, where the
affeciion is described as a primary disease, nnder the name of
fdgwarzen. My attention was directed to the investigation of
this subject only a few months ago by Dr Koch, one of the physi-
cians of the Hospital of St Paul and St Peter at Petersburg ; and
I have since that time carefully examined the patients present-
ing themselves at the Lock Hospital labouring under this dis-
ease, with a special reference to the question of its primary and
specific character, and have also, in every instance, endeavoured
to reproduce the disease by inoculation. The following is the
result erf my observations and experiments, extending over a
period of six months, viz. from 2d November 1843 to 2d May
1844.
The total number of patients admitted into the hospital during
that period was 121, and the average number in the hospital
was about 28, the whole of them being females. Of that num-
ber 36 were affected with condyloma, being about one in 3J.
One of the symptoms which struck me as most remarkable,
and present nearly in all the cases, was a peculiar hoarseness or
huskiness of the voice. This symptom was much more marked in
some than in others, but could be distinguished, I think, in all ;
even in those in whom no morbid change was visible in the
mouth, fauces, or pharynx.
The appearances presented on the genital organs and parts in
the immediate neighbourhood, were moist, indurated, and some-
what elevated patches, of a whitish and occasionally yellowish
white colour. Most of these patches were irregular in form, but
a considerable number of them, especially of those on the labia
and thighs, were rounded and prominent. They were situated
most frequently along the opposite margins of the labia majora,
on the perinaBum, and verge of the anus ; less frequently on the
outer surfaces of the labia and adjacent surface of the thighs,
and on opposite and corresponding surfaces of the thighs, two or
three inches below the labia. Many of them were the seats of
superficial ulceration, or more frequently of vesication, the sur-
face of the condyloma discharging a thin muco-purulent secre-
tion. Those which were situated on the opposite sides of the
A PRIMARY FORM OF VE^ERBAL DISEASE. 93
Rat^ were less elerated, and pf esented a tendency to ulcerate ir
fissures as they approached the yerge of the anus.
In two instances, three or four considerable condylomatous
patches, white and elevated, although flat, were seen extending
oyer the inner surface of the yagina as high as the ceryix uteri.
In nearly all the patients, the mouth or fauces presented the
appearances described by Dr Wallace as characteristic of this
affection. These consisted in white and slightly eleyated patches
on the inner surface of the lips or angles of the mouth or cheeks ;
more ifrequently on the tonsils or arch of the palate ; and not un-
frequently on the tongue, sometimes on its edges, and sometimes
on the dorsal surface near its root. So constant was the appeai*-
ance of these milk-like patches on one or other of these parts,
that I was in the habit, latterly, of examining the mouth and
throat first, after noticing the husky yoice of the patient, and
ahnost imrariably was able to detect some patch which enabled
me to prognosticate that she was affected with condyloma of the
genital organs before an examination was made. And in cases
of condylomata of the genital organs, where the mouth or throat
did not present these appearances at the period of admission,
they were not unfrequently apparent soon after during the pro-
gress of the case. To this circumstance is to be attributed the
fact to be immediately noticed, that in the journal of the cases
rather less than one-half of the patients are noted as haying had
the throat affected.
In one or two instances only, and those were cases seen at an
early stage of tihe affection, was the cutaneous eruption, de-
scribed by Dr Wallace as a concomitant of the disease, obseryed.
In those cases it presented the red-brown stain, the irregular
form, and the tendency to scale off, or rather to desquamate,
which seem to haye been regarded by him as characteri^ic.
In only one instance did there exist a distinct condyloma in
parts of the body other than those enumerated. This occurred
in the case of a patient who presented a yery large condylomat-
ous patch in the left axilla.
Of the 36 cases, one or two were apparently complicated
with syphilitic sores, as I was led to beheye by the production
of a pustule after inoculation, which had the appearance of
those produced by inoculation from the true syphilitic chancre ;
others were complicated with gonorrhoea, as was preyed by the
history of its inyasion and the appearances presented; and
94 CONDYLOMA OR SIBBENS^
others were complicated with a leucorrhoeal discharge, as we
ascertained by the use of the speculum.
Of the whole cases, 20 were accompanied with gonorrhoeal or
leucorrhoeal discharges from the vagina. Of the remaining 16,
five presented ulcers seated on the 8urfsu5e of the condylomata,
of which one or two were suspected, from the result of the
inoculation, the pustule being destroyed with caustic on its
appearance, to be syphilitic. The remaining 11 presented
neither gonorrhoeal nor leucorrhoeal discharges, nor ulcers, but
were simple cases of condyloma. Of these 11, three were wn-
doubtedly first affections, the girls not having had any previous
venereal complaint. In five of them at least, I ascertained with
as much certainty as the evidence of such patients admits of,
that the disease commenced with the formation of the condylo-
matous patches or tubercles, and was not preceded by any sores
or discharge, either mucous or purulent.
In 16 out of the 36, the throat is stated in the journal to
have presented the characteristic appearance ; but in nearly all
the remaining cases the lips, mouth, or tongue, presented the
condylomatous patches. These were most frequently seated in
the angle formed by the commissure of the lips, occasionally on
the inner surface of the hp or cheek. Those seated in the
angles of the mouth appeared shghtly excavated, and would in
all probability have been described as ulcers by most observers,
but they all presented the characteristic white or milk-like
coating on the surface.
One patient was affected with iritis during the progress of
the cure ; two with inflammation of the lymphatic glands in the
groin. Besides the oases referred to where the eruption de-
scribed by Dr Wallace was preswit, one was affected with
clustered lichen, one with rupia, and one with psoriasis venerea.
In 23 of the cases the duration of the disease, previous to ad-
mission into the hospital, was ascertained, and was as follows : —
7
2
1
2,
and in one case eight months.
The longer duration of the disease, previous to admission,
did not apparently, costeris paribus, render the cases materially
worse than many which were of shorter duration, nor make the
DoHition.
Cases.
Duration.
2 weeks in
3
2
months in
3
3
3
••»
4
4
4
...
6
4
5
••t
A PRIMABY FORM OF VENEREAL DISEASE. 95
C5tire more tedious. Of the two cases of five months' duration,
oxie was cured in fourteen and the other in nine days. Two of
^1:1.6 cases of two months' duration were cured in fourteen days,
stxid one of the cases of three months' duration in seven days.
One or two of the patients were discharged for misconduct,
some at their own request, and some remained under treatment
skM^ the date at which the report terminates ; but of the remain-
ixig cases, 27 in number, the average duration, i. e. the term of
tireatment until they were discharged cured, was twenty-two
days. Of these, two were in the hospital above two months, and
^ight between thirty and forty-five days, and in all of these cases
ttke patients laboured under chronic discharges from the uterus
ox- vagina, cutaneous eruptions, or ulceration of the throat. The
^"verage duration of the treatment in cases not affected with
"tiliese complications was twelve days.
My treatment consisted chiefiy in the application of stimu-
l^^nts to the condylomata ; the use of astringent injections and
^^old washing, for the cure of the vaginal and uterine discharges ;
^'Xii in cases of the latter kind, the internal administration of
"^^i^icture of cantharides. In several cases, when there existed
pvitaneous eruptions, the iodide of potassium was given. In no
^^■^istance was any mercury administered, except in the case of
^lie woman affected with iritis.
The local application which I have found most advantageous
^ the sulphate of copper. The condylomata were rubbed pretty
ft:"eely with a crystal of this salt, moistened with water, every
Second daj, and in some cases daily ; and a lotion of it, containing
tw^o or three grains in each ounce of water, was kept applied by
the patient. Under this treatment the condylomatous excres-
cences disappeared with remarkable rapidity. In the cases
^here there were ulcers suspected to be syphilitic, these were
touched occasionally with the nitrate of silver. The patches in
the mouth were repeatedly touched with the sulphate of copper
Or nitrate of silver, more frequently with the former, and
disappeared with equal rapidity with those on the labia and
perinaBum.
Although the treatment in the Lock Hospital has been thus
almost exclusively local, in such cases, for six or seven years,
I have not remarked any tendency in the disease to recur after
having been cured by this simple method of treatment; nor
have the patients, although many of them have been imder
treatment for* subsequent affections, presented any secondary
96 CONDYLOMA OB 8IBBENB,
symptoms, except occasionally some of the emptions mentioned
in the preyious description. The facility with which the cases
under my care were cured, I attribute, in a good measure, not
only to the effect of the remedies employed, but to the altered
habits and circumstances of the patients. The regularity of the
diet, the plain and wholesome food, the suspension of the uni-
versal habit of drinking, the attention to cleanliness, the rest
enjoyed, and remoyal from night air, constant exposure, excite-
ment, and fatigue, must in themselyes, contrasted with the usual
habits of prostitutes, tend to produce a marked effect on the
diseases under which they may labour.
The obseryations recorded in the preceding pages haye led
me to the conclusion that this affection is a primary form of
venereal disease, and that it is identical with sibbens.
With respect to the first opinion, I must admit that it is ex-
tremely difficult to obtain complete satisfaction, in the class of
patients among whom I haye studied this affection, as to the
absence of any previous disease, gonorrhoeal or syphilitic. Of
the eleven cases which I have mentioned as having neither ul-
cers, gonorrhcBa, nor leucorrhoaa, after repeated examination and
cross-questioning, I was only able to satisfy myself that the
disease had made its first appearance in the form of a condylo-
matous tubercle, without any previous ulcer or discharge, in five
of the patients. In three of the cases, the patients were un-
doubtedly labouring under a venereal'affection for the first time.
One of them, indeed, was under ten years of age. She pre-
sented a condyloma on the right labium, the surface of which
was ulcerated, or rather vesicated, another on the verge of the
anus, several patches on the tonsils, one on the lips, some of
considerable size on the tongue. The disease was contracted by
sexual intercourse. A companion of this girl, under eleven
years of age, was similarly affected, although to a much greater
extent, and in her the disease was contracted from the same
source.
I was at one time strongly inclined to believe with Dr Hibbert,
that this disease was *' the engendered product of rank unclean-
Uness,"* for it is certainly most frequently met with in patients
of the lowest class, and is generally accompanied with profuse
and neglected discharges. But the number of cases in which I
have seen it where there was no such discharge, have satisfied
* Edinburgh Journal of Medical Science, 1636s
A PRIMARY FORM OF VENEREAL DISEASE. d7
me that this is not the sole cause, although it may be admitted
that under its influence the disease is fostered and dereloped.
My opinion on this point exactly coincides with that of Dr
Wallaoe. '' The want of habits of cleanliness/' he observes^
'' has a great influence in determining the formation of fungi, of
rhagades, and perhaps of onyxis. In fact, these symptoms are
often produced by the dirty habits of patients, when the opposite
habits wouM hare prevented them. I do not, however, say that
they never occur except in such habits, for I have known very
cleanly persons to have the condylomatous form of disease."*
The invariable affection of the mouth and throat at some period
of the disease — ^for I am satisfied it is invariable — ^with the pecu-
liar aad perfectly characteristic eruption, or condylomatous
patches, in itself is sufficient to point out that this disease is
«peca&e in its origin, and essentially different from any of the
secondary symptoms which are known to result from the syphi-
litic virus, or from any thing which can be produced by filth and
gdnorrhcBa.
To satirfy myself, if possible, of the specific character andccm-
tagious nature of this disease, I inoculated in every one of the
cases referred to from the matter, which can in general be scraped
from tiie surface of some of the condylomata, or from the ulcers
which they frequently present. The result of these experi-
ments has be^i different from either that of Dr Wallace or M.
Rioord, between whose results there also exists a remarkable
diBcrepancy.
Dr Wallace states, that in " two or three weeks after" [ino-
culation], "the seat of the inoculation swelled and became
somewhat red and painful. It then desquamated, or appeared
scaly. The tumidness and scaliness increased. The scales then
gradually became scabs or crusts, and the spot as gradually ac-
quired a fungoid elevation. In a few instances the scaly
tubercle, soon after its appearance, formed an ulcer. On other
occa^dons parts of the fungous elevation ulcerated, and then its
surface appeared depressed, or in wells. "| He adds, that the
secondary symptoms followed, the skin presenting the rubeoloid,
or the scaly, or the tuberculated eruption, and the mouth the
superficial form of the disease.
M. Ricord states, that in 221 inoculations from mucous tubercles
or condylomata, no effects were produced in any case.
• Op. Cit, p. 751. t <^P- Cit., p. 133.
98 CONDYLOMA OR SIBBENS^
On comparing the results of M. Ricord's inoculations witli
those of Dr Wallace, I was at first led to believe that the dis-
crepancy was probably to be explained by the supposition that
M. Ricord was not aware of Dr Wallace's experiments, or did
not advert to the circumstance stated by him, that the inocula-
tion did not take effect until two or three weeks afterwards, and
that before that period he might have ceased to watch for any
effects. The result of my own observations, however, is at
variance both with this explanation and with the experience of
Dr Wallace ; for in the only cases in which my inoculations suc-
ceeded, the effect took place within one or two days.
Of the thirty-six cases referred to in the preceding part of this
paper, inoculation succeeded in only four cases. In all of these
the first appearance presented in the seat of the inoculation was
a pustule on the second or third day, as in inoculating from a
chancre. Believing that this had been the case in the first two
or three experiments, I destroyed the pustule with nitrate of
silver. In the fourth case I sdlowed the two pustules which
formed to run their natural course; a scab formed, which
appeared to be seated on sores depressed below the level of the
adjoining surface, but without the elevated or hardened edges,
or the defined circular form of chancre. They continued in-
creasing in size, preserving the same appearance and covering,
until they met each other and coalesced. On the fourteenth
day after inoculation the crusts became detached, and a fungoid
excrescence, having all the appearance of a condyloma, shot up
from the sore. This was destroyed.
In another case, not included amongst the thirty-six referred to,
inoculation produced the same effects as those last described;
and the sore now presents a small fungoid elevation of the skin,
somewhat resembling a condyloma. In addition to the results
derived from direct inoculation, I may add, that I have had fre-
quent occasion to remark the existence of a condylomatous
tubercle on opposite surfaces of the thighs, at points exactly cor-
respondmg, and brought in contact when the thighs were
approximated.
These results are as yet imperfect and unsatisfactory, but so
far as they go, they are confirmatory of the observations of Dr
Wallace, in as far as regards the appearances presented, although
they are at variance with his results, both as regards the
pustular form which preceded the scab and tubercle, and the
period at which the inoculation took effect.
A PRIMARY FORM OF VENEREAL DISEASE. 99
That inoculation took effect in so few of the cases experi-
mented upon by me, may be explained, perhaps, partly by the
fact that I selected a part of the thigh where condylomata are
yery seldom produced in the natural course of the disease, and
j)artly, it may be, by my not having had recourse to any means
to prevent the patient washing the inoculation immediately
after it was done, to prevent its taking effect. Dr Wallace
states that his inoculations succeeded much less frequently than
inoculations from chancres.
The inference to be deduced from the experiments referred
to, more particularly those of Dr Wallace, appears to me to
afford strong corroborative evidence of the opinion which I have
formed, that this affection is specific, and one of the primary
forms of venereal disease.
The identity of this disease with the affection called sibbens,
which at one time ravaged this country to a great extent, and is
now generally believed to be nearly extinct, or confined to some
limited localities in the west and north of Scotland, is, I think,
very clearly made out by a reference to the descriptions of it
which we possess. This question, or the question of the venereal
origin of sibbens, is not likely to be encumbered now with argu-
ments founded upon the possibility or impossibility of curing it
without mercury, any more, I trust, than the syphilitic nature
of any of the diseases met with in the Lock Hospital is to be
doubted because they have been treated and cured there without
any mercury for the last six or seven years. The question will
be determined by the anatomical characters of the disease.
Dr Gilchrist, in an account published in 1766, of sibbens as it
appeared in Scotland at a time when it was very prevalent, says,
" It first appeared here in the form of a sore throat, or an in-
flammation of the uvula or pap of the hawse, as it is termed,
and neigbbouring parts. The tonsils were often superficially
ulcerated, appearing either raw or covered with a white slough.
Frequently there was a thrush, that is, white specks and sloughs,
npon the roof of the mouth and inside of the cheeks and lips,
which commonly showed itself at the corners of the mouth, in a
»rmll rising of the skin, of a pearl or whey colour" * ♦ •
" Sometimes there was a hoarseness." — " Scabby eruptions were
often met with on the scalp, forehead, inside of the thighs,
groms, and parts contiguous." — " The whole surface of the body
appeared mottled or flaked, of a dusky copper colour, or dirty
100 CONDYLOMA OB SIBBENS,
red." — '' Inflammatios, sorenesses, and excrescences about the
fundament were frequent."*
In an account of the disease '' falsely called the yaws in the
south of Scotland, and eibbens in the north," hj Mr James Hill,
surgeon in Dumfries, written in 1768, after referring to the
Terrucfo, condylomata, and tubercles met with on the perinaeum,*
scrotum, and various parts, and citing the descriptions of Dr
Harvey, Wiseman, Turner, Dr Barrie of Cork, Van Swieten,
Plenck (all whose cases, he says, are sibbens), and Boerhaaye,
to show that the distemper called venereal syphilis or French pox
in France, Germany, Holland, England, and Irelaad, is the same a»
the Scotch sibbem, he describes its s^pearance in the mouth in the
following graphic terms : — " When the infection is ccnnmunicated
by a foul pipe or spoon, the angles of the mouth, the lips, gums,
&c., are first affected. The first appearance of an ulcer <m the
lip, &c., exactly resembles a bit of fine white soft velvet pasted
upon the skin ; for it will not wipe off. But after it has eaten
in for some time, it then has the appearance of a piece of the
red skin cut out, and a white velvet patch put in its place.
These ulcers spread broader than deep."t To prove its identity
with syphilis, he rdTers to a case of ''clap" in afemale, ''attended
with verrucfe, which she called haemorrhoids," and who communi-
cated sibbens to nine of his own relations.
Dr Adams visited Scotland, as a '^ means of assisting his inquiries
into morbid poisons," for the express purpose of examining the
sibbens, believed then, as it still is, to be prevalent only in the
south-west of Scotland, The description of the patients whom
he saw confirms the opinion which I have formed of the identity
of the diseases. One female had lost her uvula and tonsils, her
voice was affected, and, adds Dr Adams, " the loss of substance
about the lips is very trifling, but the edges are covered with an
opaque white cuticle, apparently newly formed." * * «
^' She had at one time complaints about the anus." Of anoAer
female whom he examined, be says, ^' The uvula and tonsils were
suffiised with a viscid mucus, and in some parts covered with the
white appearance before mentioned. The soreness extends from
the edge of the lips along the inside of the cheek and side of the
tongue ; but if there be ^y loss of substance, it is only at the
uvula and tonsils, which appear rather wasted than ulcered."
• Phytical and Literaiy Bsgays, vol. iii. p. 154-177. Edinburgh, 1771.
•f- Cfiies in Surgery, by Jiimes Hill, Surgeon, p. 258. Edinburgh, 1772.
A PRIMARY FORM OF VENBREAL DISEASE. 101
She bad also a cutaneous eruption, of which Dr Adams says :
'' These are small elerations above the cuticle ; she showed me
some on her legs and arms, which seemed pustular, but were
quite dry."* Other cases are referred to of a similar kind, from
a review of which he arrives at the conclusion, that sibbens is
different from the venereal disease. Its prevalence in Scotland
is explained by Dr Adams by reference to the habit, which, he
says, was peculiar to some districts of Scotland in those days, of
smokiog out of a common pipe — of *^ using a single pipe for a
whole family, and almost for a whole village" I The tradition,
regarding the origin of the disease in Scotland was, that Crom-
well's soldiers had introduced it and the smoking of tobacco at
the same time, by means of their pipes.
The idea generally entertained of this disease by, I believe, all
who have written on the subject, in common with Dr Adams and'
the writers referred to, that it is communicated by kissing, or by
driilking out of the same vessel or smoking out of the same pipe,
I am inclined entirely to discredit. I behove it has arisen, along
with the idea that this is a disease which chiefly or solely, in
some instances, affects the mouth, from the &ct that in every
case the mouth is more or less affected at the same time as the
genital organs. The affection of the mouth is one of the consti-
tutional effects of the disease, to be observed, I believe, in every
case of condyloma at some period of its course. And I have
little doubt that the erroneous ideas generally entertained re-
garding the nature and mode of propagation of this disease, have
originated in the desire on the part of those affected with it to
conceal the real origin of their complaint. Had the genital
organs been examined in every case where the mouth was affect-
ed, I behove the medium of contagion would have never been
suspected to have been merely kisses, tobacco pipes, or common
drinking cups.
Mr Carmichael, believing with Dr Adams that this disease
was endemic in Scotland, particularly in the western part of it,
conjectured that it must be frequently transmitted to Ireland,
and accordingly he recognised its frequent, almost daily, occur-
rence in the Lock Hospital of Dublin. These were undoubtedly
cases of condyloma, and not more pecuhar to Dublin, if the
account given by Dr Wallace of his exanthematic syphiUs is
correct, than to the west of Scotland.
* On Morbid Poisons^ by Joseph Adamsy M.D., p. 183-8. London, 1807*
102 CONDYLOMA OR SIBBENS,
The limits of this paper prerent me from endeavouring to
trace the identity of this disease with the renereal affections de-
scribed by the older writers, but I cannot avoid remarking that
one can scarcely refer to any old work on syphilis without a con-
viction that it has been very generally described and confounded
with syphilis. To take e. g. at random a single observation from
a small work by Dr Saunders, to which is appended the tract
by Professor Plenck on the action of mercury on the salivary
glands : " A child of a year and a half old, whose parents were
not venereal, had for half a year condylomata about the anus,
rhagades, and small ulcers in the angles of the mouth,*' &c.*
One can hardly resist the conclusion, that a more careful exami-
nation of the subject will show that sibbens is as familiar as
syphilis, and as httle peculiar to certain localities, and that it has
been overlooked or ascribed to the secondary effects of that
The most recent account of sibbens, as it prevails in Ayrshire,
Galloway, and Dumfriesshire, is contained in a very interesting
paper by Mr Wills of Cumnock, published in April last,f which
I have just seen for the first time. On perusing it I was grati-
fied to find all my preconceived opinions, regarding the identity
of the condylomay daily met with here, with the sibbens of the
west, confirmed and verified. The appearance of the tubercles,
or condylomata, on " the tongue, cheeks, angles of the mouth,
anus, groins, and genital organs," and of the cutaneous eruption
or secondary symptoms, given by Mr Wills, is exactly applicable
to the cases daily seen in the Lock Hospital of this place. While
I differ from him regarding the necessity for the use of mercury
in the cure of this disease, and regarding the mode in which the
affection of the mouth is produced, his views entirely coincide
with mine on most of the other points of interest. ** Between
sibbens," he says, " and the venereal condyloma, there does not
appear any difference ; and I will be much astonished indeed if,
on farther inquiry, the latter is not found to be often communi-
cated by the mouth. Whether sibbens may have wandered from
our mountains to the cities, or venereal condyloma from towns to
us, is not for me to decide."
Mr Wills recognises the resemblance between sibbens and
the disease described by Mr Johnson as venereal condyloma,
* A New and Easy Method of giving Mercury, Slc, by William Saunders,
M. D., p. 83. London, 1768.
f London and Edinburgh Monthly Journal of Medical Science, April 1844, p. 282.
A PRIMARY FORM OF VENEREAL DISEASE. 103
in such terms as to satisfy me that little remains to be done to
establish the identity of tHe two ; although I am still inclined
to believe that the idea of the Cumnock disease being propagated
bj contact of the lips or tobacco pipes is fanciful, and founded
upon a limited view of the constitutional symptoms of the
affection. " Mr Henry James Johnson, in the April number
of the Medico-Chirurgical Review for 1834, in giving an ac-
count of this fungoid venereal sore, under the name of venereal
condyloma, has presented so minute and faithful a description
of sibbens, as it at present exists in this part of Scotland, as
almost to make me doubt if that gentleman had not his model
from Ayrshire, with this difference, that what he calls a secon-
dary affection is our primary. This is easily accounted for.
Mr Johnson ha^ been in the habit of seeing the disease in the
form it assumes when got by coition ; we again commonly meet
with it as caught by contact of the lips, or through the medium
of tobacco pipes, &c. Sibbens, however, are frequently com-
municated by coition ; and then the disease has all the characters
of venereal condyloma." And again, " Their appearance on the
female parts of generation is so accurately described by Mr
Johnson, that I would only be copying that gentleman's words
in attempting a description ; but I may take this opportunity of
stating, that sibbens caught by coition are not always accom-
panied with gonorrhoea, and are oftener without than with that
discharge, particularly in males."
From the preceding observations and experiments, I think
myself warranted in deducing the following conclusions as highly
probable if not completely substantiated : —
1. That condyloma is a primary form of venereal disease —
specific in its characters and its origin, and distinct from
gonorrhoea or syphilis.
2. That it is identical with the disease described under the
name of sibbens or sivvens.
3. That it is communicable by contagion and inoculation.
4. That the difficulty of producing it by direct inoculation,
and the similarity of the affection of the mouth in eases pro-
duced by sexual intercourse with that in which it has been
supposed to be produced by contact of the lips, &c., render it
probable that the affection of the mouth is always a constitutional
symptom resulting from a venereal origin.
5. That it is curable without the use of mercury.
Before concluding, I take this opportunity of acknowledging
104 DEATH BY RUPTURE OF THE LUNG
mj obligations to Mr Benbow, the present active and intelligei^
house-surgeon to the Lock Hospital^ for the efficient assistance
which he rendered to me in the investigation of this subject, in
the cases referred to as reported and experimented upon there.
Case of Death by Rupture of the Lung from Violenee withofut
Injury of the walls of the Chest. By William Tait, M.D.,
Surgeon to the Edinburgh Police.
On the 18th of March last, I was called about noon to the West
Port, to see a girl who was reported to have been run over by
a parcel-van, and to have received considerable injury. Having
acddentally met a medical friend on the street, I requested him
to accompany me, and we examined her together. She appeared
an interesting child, about three years of age, well formed,
plump, and healthy.
The clothes having been previously removed, every part of
the body was carefully examined, and no external injury was
observed, with the exception of a slight abrasion of the cuticle
over the deltoid muscle of the left arm, and a faint livid line,
about an inch broad, extending from this to within two inches of
the elbow, and a spot of ecchymosis, about two indies square,
over the crest of the left ilium. The breathing being much af-
fected, and considerable pain being produced by a full inspiration,
our attention was specially directed to the state of the ribs and
the vertebral column, but not the slightest crepitus or other in-
dication of fracture could be discovered.
She was reported by the parents to have been spitting blood
before our arrival, but we had no positive evidence that this had
come from the lungs, and were of opinion that it had flowed from
a slight bruise of the gums, from which blood still appeared to
be oozing. On applying the ear to the left side of the chest, a
combination of the mucous and crepitating rattles was distinctly
perceived, and we considered it probable that the lung had sus-
tained some injury, but were not inclined to view it as of a very
serious nature, as the wheel of the van did not appear to have
passed over the chest.
The child was put under the charge of the medical attendant
of the family, was freely leeched on the chest, but died on the
evening of the following day, about thirty-five hours after the
FROM EXTERNAL VIOLENCE, 105
acddent^ — ^haying for seyeral hours before death expectorated a
eonsiderable quantity of blood.
The drirer of the Tan having been apprehended on a charge
of carelffls driving, Dr Weir and I, by virtue of a warrant from
the ma^stratefi of Edinburgh, made a post-mortem examinatioa
of the body on the afternoon of the 20th, the day after death.
The traces of ecchymosds, on the external aspect of the left arm,
aad on the crest of the le£b iUum, were then more ^stinct than
when examined immediately after the acddenk had occurred, but
no additional mark of extenial injury was observed. On laying
op^ the different cavities, the brain and abdominal viscera were
foimd to be quite healthy, but more blanched than usual. The
left cavity of the chest contiuned fully a pound of fluid venous
blood, and the lung was considerably collapsed. There was a
rapture of the left lung fully four inches in length, commencing
aWt the middle of the anterior margin of the superior lobe,
and extending across the lung. From the inner extremity of
the wound a second rent, about two inches in length and more
snperfidal than the former, extended forwards in the direction of
the margin without reaching it, so as to give to the rupture the
form of the letter V. The portion of lung situated between the
extremities of the letter was ahnost detached, and turned back in
SQch a way aa to appear at first sight altogether unconnected with
it. A eonsiderable quantity of blood was found effused into the
parenchyma of the lungs, and also into the bronchi. Lymph waa
effused upon the surface of the pleura pulmonalis ; and a circular
patch of ecchymosis was observed upon the external surface of the
pericardium, corresponding with the left ventricle of the heart.
From these appearances, we gave it as our opinion that the
duld had died from the loss of blood, consequent upon the lesion
rfthe lung ; and that this injury itself was probably the result of
severe pressure, appUed externally at the moment of a full iu-
q)irati0n.
Whether the opinion fifl to the cause of death, or the manner
in which the wound of the lung had been produced, be correct
or not, this case is interesting in its medico-legal bearings, in so
iar as it oonfirms the fact, already ascertained, that there may
be fatal lesion of an internal organ from force applied externally,
while not the slightest indication of violence can be observed on
the surface of the body. Cases illustrative of internal rupture
without outward mark of iqury, are related by Drs Geoghegan,
Watson, Williamson, Henke, Taylor, &c. The abdominal viscera^
106 DEATH BY RUPTURE OF THE LUNG
however, appear to suffer more frequently in this way than the
lungs. In the latter it is comparatiyely rare, as might be anti-
cipated from their being better protected, and their peculiar tissue
being less Ukely to suffer from pressure than any other organ
contained in the body. From experiments made upon the lungs
of animals, we are satisfied that very severe pressure will not
produce a rupture of these organs, and that some other agent
must have been called into operation to produce it on the occa-
sion referred to. The part of the lung injured appeared to havQ
been compressed or twisted between the opposing forces. Had
it been possible for a part of it to have become wedged between
two of the ribs, it would at once have explained the mode in
which the injury had been inflicted ; but conceiving this to be
physically impossible, any suggestion which we are prepared to
advance in order to account for it must be very unsatisfSEtctory.
A case came under my notice in May 1843, of a woman who
died from rupture of the spleen and effusion of blood into the
peritoneum. Both she and her husband were much intoxicated,
when a quarrel ensued. The husband attempted to kick her,
and she fell on the edge of a table. She died three days after.
On an examination of the body, no marks of ecchymosis were
observed but on the arms and shins. When the abdomen was
opened, coagula of blood were found floating amongst a quantity
of serum, and coagulable lymph in the cavity of the peritoneum^
which were discovered to have come from a rupture of the spleen
and its peritoneal covering, about three inches in length.
NOTE BY THE EDITORS.
As remarked above, the rupture of the lung is much more
rare, under such circumstances, than that of the heart and abdo-
minal organs.
Dr John Gairdner of Edinburgh, in the Edinburgh Medico-
Chirurgical Transactions, reported an interesting case, where
the injury arose from the wheel of a loaded cart, as in the above
instance. The accident occurred in a girl ten years of age, and
her death was immediate. " There was scarcely any percep-
tible trace of the impression of the wheel externally, and no
subcutaneous extravasation, except a very shght one under the
left nipple.
" In the thorax, the only deviation from the healthy state was
the rupture of the heart, with extensive laceration of its sub-
FBOM EXTERNAL VIOLENCE. 107
stance. Both ventricles and both auricles were laid open by the
laceration, and the septum was torn to shreds. About one-half of
the substance of the heart had burst a way for itself through the
pericardium into the right cavity of the thorax, where it was
found immersed in a very large quantity of grumous blood, and
still attached to the other parts by means of a small portion near
the apex, where the rent had stopped."*
Notwithstanding the extent of the rupture, as in the above
case, there was hardly any mark of hurt externally, and no rib
was in the slightest tlegree injured.
This case at first sight appears to come very close to that
above reported ; but while there was rupture of the heart, the
long appears to have been uninjured. And a considerable num-
ber of cases besides are recorded, in which the heart was rup-
tured under similar ch*cumstances.
The liver, the spleen, the kidney, the intestines, have been
also frequently ruptured by external violence without any marks
of injury on the surface. But authors appear to have been
rather rash in stating the same to be true of the lungs. It seems
likely that the lung cannot be ruptured under such circumstances,
or without fracture of the ribs, except in very young children.
We cannot call to mind a distinct case of rupture of the lung
anywhere recorded similar to that above reported. And on
closer inspection, those commonly referred to under this head
will be found to be less cases of rupture than of wound. Beck,
whom nothing in general escapes, refers to the Medical Gazettef
alone for evidence of rupture of the lung without external ap-
pearance of injury ; but the writer in the Gazette, in the case
alluded to, refers the breach in the lung to perforation by a
fractured rib. Again, one of the writers in the Gazette refers
to Morgagni for a case of the same kind. But Morgagni does
not state what the condition of the surface was, and describes
the ribs as being extensively depressed and fractured, at the
same time that there was an aperture in the lung.^ Morgagni's
case may be a case of rupture, but the evidence afforded in the
report is far from satisfactory,
* Edinbnrgh Medico-Chinu^cal Transactions, toL i. p. 662.
t Vol XV. pp. 668, 727, 729.
t For some valuable observations on the conditions under which blows produce
different effects, see the << Medical Jurisprudence of Blows and Contusions,** Pro.
bttioDsiy Essay, by David Skae^ F.R.C.S.E. 1836.
108 CU6ABIUTY OF BYPBOOEPHALUS.
On the ready CurabUihf of the mare acute Form of Hydro-
cephalus, i/n its earliest Stage, under aicdve Treoitment; wUh
a Case. By Alexander Harvet, M.D., Lecturer on the
Institates of Medidne in Marischal College aad Uniyerfidty,
Aberdeen.
It is on all hands admitted that the acute hydrocephah» (using
that term m equivalent to acute inflammation and ita effieets, of
the brain or its membranes) shows little err no tendency to a
spontaneous favourable termination, and very quickly passes into
a state which, although not absolutely intractable by remedies,
nor inevitably fatal, is yet very litde under their control, and
Tery seldom recovered from.
There is considerable difference of opoion, however, as to ti^
degree in which it is amenable to remedies within die first two
or three days from its outset. Formerly, when as yet the true
nature and the proper treatment of the disease were unknown or
imperfectly understood, it was very generally beheved that ev«i
at that early period the genuine hydrocephalus is singularly litde,
if at all, susceptible of the influence of remedies of any kind.
This persuasion, however, of its peculiar obstinacy does not now
obtam, at least to that extent, or is entertained by comparatively
few, and the greater part of the profession seem to look upon it
as neither so intractable nor so fatal as it was viewed by the first
writers on it.
But this mere general admission in favour of the curaKlity of
the disease is made with very different degrees of readiness by
differ^it practitioners. Some very competent observers seem to
be decidedly of opinion that, within the period specified, the
more acute and well-marked form of it yields comparatively
readily to active treatment, particularly cojrious and repeated
blood-letting and full purging ; and to have satisfied liiemselves
of the actual accomplishment of a cure> in thdbr own practice and
under such treatment, in a considerable proportion of cases, or
even in the great majority of cases.
I apprehend, however, that the great bulk of <ite profession
have no such lively persuasion of the curability of the disease,
nor any such confidence in the efficacy of treatment, even in its
more acute form and in its earliest stage ; and that it is a fair
account of their experience to say, that, of the cases of that kind
seen by them from the commencement and then brought under
CURABILITY ,OF HYDROCEPHALUS. 109
treatanent, although more or fewer of th^i rfecoyer, the larger
proportion terminate fatally.
And there are still, as formerly, not a few, though few oom'«>
paratively, who hare either strong misgivings w are positively
sceptical as to the curability of the genuine hydrocephalus at any
period or in any form. Their own experience of it has, perhaps,
been so uniformly unfavourable as to have created or strength-
ened a conviction in their minds of its being almost necessarily
&4al ; and so strong is that conviction, tiiat tbey do not hesitate
eonfidently to avow their belief that those of a contrary persuamoii
are either singularly credulous, or greatly deceive themselves in
regard to the evidence on which that persuasion is founded ; and
that l^e cases adduoed by them as examples of hydrodephaluB
dared in its earliest stage had not been cases of that disease ait
all, and are '^ remarkable only for thdr singular resemblance to
it.''
And therfe is yet another, and perhaps a still larger class of
practitioners, who do not question abstractly the curability or
er&i the ready curability of this disease during the diort period
specified, but doubt or deny the possibility of recognising it at
that time, except in a very few cases, with su^ient certainty to
warrant active interference, and condemn perhaps, or at least
practically disregard, the principle of being guided in the treat-
ment of doubtful cases by probabilities of a low kind as to tbdr
real nature. In regard to many of the cases which come before
them, they may from the first have strong suspicions — suspicions
which are often painfally justified afterwards ; but they do not
feel themselves called upon, on the fsdth of these, to subject
their patients to the active treatment which tliey would at
once adopt were they fiilly satisfied that they were labouring
under actual hydrocephalus. Their experience of the disease,
accordingly, is perhaps as unfavourable as that of the preceding
class ; but they attribute their want of success, not to any pecu-
liar obstinacy in the disease to the influence of active treatment,
but to the impossibility of making out the diagnosis in its early
stage.
Nothing is more certain than that the settled convictions of
our minds in regard either to the curabiUty of the disease or the
diagnosis of it, in its early stage, will very materially influence,
though insensibly it may be to ourselves, our conduct in this
department of practice. And, accordingly, it will be found, I
110 CURABILITY OP HtDROCBPHALUS.
apprehend, that those who entertam a confident persuasion of
the ready curability of the disease, at the period and under the
treatment already mentioned, and are impressed with the impor-
tance of being satisfied, in judging of the diagnosis, with indica-
tions much short of certainty, are at once prompt and energetic
in their practice ; that those who are more or less sceptical as
to its curability, or require rather clear evidence of its existence,
are so far influenced thereby, in cases at least which are at all
doubtful, as to decline or defer any very active or decided prac-
tice; and that those who, though agreeing generally in the
views of the former class, are less confident in their apprehension
of them, and less sanguine as to the general elBicacy of bold and
energetic practice, are proportionally less prompt and decided
in their treatment.
And what if the views of the first class, and their statement
of the successful results of practice, are well foimded ? What if
it be true that hydrocephalus, in its more acute form and in its
earliest stage, is readily amenable to active treatment, and that
its diagnosis may in general be then made out with sufficient con-
fidence to warrant such treatment ? And what if the views of
the others are erroneous, and their unfavourable experience of
the disease attributable to inefficient practice, or to active prac-
tice either too long deferred or carried to a degree short of what
the disease requires? These are obviously questions of the
utmost practical importance.
Being myself satisfied that the evidence adduced and relied
on by those who believe that these questions admit of an affirma-
tive answer, has stronger claims on our consideration than many
suppose, or at least that '^ it is not so clear a case that there is
fwthvng in it,'* I think it might not be amiss, for the sake of
those who have never carefully examined it, to lay that evidence
formally before them, and to urge upon them whether, if, upon
a due consideration of it, it shall not appear altogether satisfac^
tory to their minds, it is not, at all events, such as to require of
them a line of conduct nearly, if not exactly, the same as if it
were in the highest degree conclusive ; and whether, also, it is
not our duty, in deaUng with a disease of so intractable a cha-
racter when fairly established, and so hopeless when left to itself,
to act in doubtfid cases upon indications of a slight nature, and
on low probabilities as to their curability in all cases, and not de-
cline or defer the adoption of active treatment till we have some
CURABILITY OF HYDROCEPHALUS. Ill
sort of certainty as to the nature of the cases on the one hand, or
on the other, clearer evidence than yet appears of the efficacy of
such practice.
It is certain, indeed, that if we are habitually guided in our
treatment of this class of cases by such principles as these, " it
will be impossible for us to say how many of those cases which
under active treatment terminate favourably, would otherwise
have ripened into well-marked hydrocephalus ; and we must be
content to have it said, without its being possible for us to
refiite the assertion, that not all of the disorders which we
treat as acute hydrocephalus are really instances of that com-
plaint."* Nay, doubtless, it must happen that, acting on such
principles, — guided often in a great measure by conjecture, —
" not waiting till the nature of the symptoms demonstrate that
the malady is present, while they demonstrate also, at the same
time, that it is well-nigh hopeless,"t we shall occasionally sub-
ject patients to a plan of treatment which, could we get behind
the scenes, we should perceive to be unnecessary. But in regard
to this disease, it is especially important to remember that
'''probability is the very guide of lifCy^X and that "in those
diseases in which most can be done by art, our practice must
always be guided in part by conjecture, because, if we wait for
certainty, we very often wait till the time for successful practice
is past."§ And, if err we must at times, better far the re-
flection, at the close of our professional life, that if chargeable
in this particular instance with the nimia cura medid, we
have at least lost comparatively few cases of acute hydrocephalus
seen by us from the commencement, than that of being guiltless
in that respect, but of having lost many such cases.
I propose, then, to state somewhat formally and in detail
the evidence in favour of the beUef which is entertained by
some very competent authorities, that the hydrocephalus, in its
more acute form, is, in its earliest stage, very generally amen-
able to active treatment, and that the diagnosis of that form of
it may generally be made out at that stage with sufficient con-
fidence to warrant active interference.
I must defer doing so, however, till a future occasion, and
• Watson's Lectuieu on the Practice of Physic, p. 428. f Ibid.
t Batler's Analogy, Introduction.
§ Alison, History of Med., Cyc of Prac Med., yoL L p. IzzzTiL
112 CURABILITY OF HYDROCEPHALUS.
'will in the mean time conclude tibese remarks with the following
case, which fell under my care yery recently, and which in my
opinion admirably illustrates the force of them.
Case.
A young gentleman, setat . fourteen, one of a family of whom three
had died of hydrocephalus, and himself sufficiently remarkable
for the '' acuteness of his senses, and the activity of his mental-
powers of observation and apprehension," so often seen in the
victims of that complaint, — after being confined to the house
for some days on account of a slight cold, began to complain
the week following of acute pain in one of his temples, attended
with some quickness and sharpness of pulse at night. For
these symptoms he was again confined to the house, and smartly
purged. On the third day thereafter, the pain had considerably
abated, and on the morning of the fourth he seemed to be quite
well.
On the evening of that day, however, the pain returned, and
besides bemg as acute as formerly, now affected both temples
and the forehead. On seeing him next morning, I learned that he
had passed a restless night, and had been frequently wakened out
of sleep by the severity of the pain ; and that the pain itself,
while more acute than that of ordinary headach, darted at
times through his head in stounds or twiages, was easiest when
he lay quietly in bed, and much aggravated on moving his
head or assuming the erect posture. His head felt sensibly
warmer than natural, but there was no throbbing^ of the
temples nor flashing of the face, and his pulse was tranquil.
He had been much sickened by some medicine he had taken at
bedtime, and had vomited several times in consequence ; and
this was observable as the effect of the medicine he had taken
in the earlier part of the week.
These symptoms — especially the character of the pain — ^taken
in connexion with his presumed tendency to hydrocephalus,
seemed to me to warrant suspicion of their being dependent on
incipient inflammation within the head. I therefore immediately
bled him from the arm to the extent often or twelve ounces, with
the effect of inducing faintness, sickness, and vomiting. Thereafter
I had his hair cut short, and cold assiduously and effectually ap-
plied to the head, and prescribed for him strong purgative
medicme. The pain of the head was considerably relieved by the
CURABILITY OF HYDROCEPHALUS. 113
bleeding. The blood drawn was very distinctly buffed. The
medicine sickened him a good deal, but purged hhn fully and re«
peatedly in the course of the day.
Next morning, the pain of head, though much easier, still
continuing to come in stounds, I again bled him from the arm
to the same extent, and with the same effect, as yesterday.
This bleeding entirely and at once removed the pain. The
blood was even more sizy than on the former occasipn, and
much contracted. The purging was kept up briskly, and the
cold applications to the head were continued.
The pain did not again return ; he regained his strength
ra|xdly ; and in less than a fortnight was allowed to resume his
wonted occupations.
The distinctly inflammatory appearsmce of the blood (trawB
strengdiened my suspicion that the case was one of inflammation
within the head, in its first stage ; and the rapid abatement of
the symptoms consequent on the bleeding and purging, and the
speedy convalescence, notwithstanding the weakening effect of
Ihese, heightened it still more, as indicating that an inflammatory
disease had been cut short,*
Should any one, however, dispute the inference thus drawn
as to the nature of the case, I shall not insist upon it. I at once
admit th^t the inference is only a probable one ; and that, had
the pain been more distinctly violent — shooting through the head
with such intensity as to cause screaming — ^had there been marked
sickness, and vomiting of all or nearly all ingesta, delirium, and
quickness and sharpness of pulse, my own mind would be niuch
b^ter satisfied in regard to it. I take leave, howeverj to re-
mark, that ihe symptoms were precisely similar to those att^ading
the commencement of many cases which have ended in fatal hy-
drocephalus, and in particular to those described by Dr Aber-
crombie as constituting his fourth and fifih variety of this class
of head affections ; and that, unless such a one is disposed to deny
the inflammatory nature of that disease, or, admitting this, to
deny the curability of it, even in its early stage, he cannot surely
i^fiise allowing, that the whole circumstances of the case were
such as not only to justify the treatment adopted, but imperatively
to demand it.
Ab£ai>eek, Majf 17> 1844,
* Brit and For. Med. Renew, toL ui. p. 307.
114 UNUSUAL TERMINATION OF A CASE
Unusual Termination of a Case of Congenite Hydrocephalus.
By William Campbell, M. D., Lecturer on Midwifery, and
Consulting Physician- Accoucheur to the Maternity Hospital,
Edinburgh.
Mrs Brown, set. twenty-two, healthy, among the industrious
classes, produced, on the 2d of April of this year, in her second
confinement, a large female foetus affected with hydrocephalus.
The male parent was healthy, and twenty-four years of age.
During labour the breech presented; and the transit of the
foetus was so tardy, that Mr William Malloch, a very intelligent
pupil, who had the management of the case, deemed it necessary
to request the assistance of Dr Cochran, a neighbouring practi-
tioner. After a good deal of active traction, a still-bom child
was extracted. The head was much enlarged, greatly elongated,
and so squeezed together, owing to the compression to which it
was subjected while it was being dragged through the pelvis, as
to resemble a tin kettle or canister which had been exposed to
much pressure ; and although from its great expansion it was
evident that it must have contained a considerable quantity of
fluid, yet it seemed nearly empty. There was a spina bifida
of considerable magnitude formed on the sacro-lumbar junction,
which had been burst during labour, and through which the fluid
contents of the cranium*, passing along the spinal canal, made its
escape. Some years ago, in an infant affected with spina bifida,
the pressure of the hand apphed to the tumour was observed to
cause the young subject to become comatose ; and hence there
was satisfactory evidence that a communication existed between
the tumour and the brain.
After the cranium in the foregoing case was distended to the
volume which it possessed previously to the escape of its contents,
it measured, by callipers, after being denuded of the soft parts,
— ^from the chin to the anterior angle of the left parietal bone,
6^ inches ; from the chin to the posterior angle of the same bone,
at the extremity of the sagittal suture, 6^ inches ; from one pa-
rietal protuberance to the other, 5| inches ; and in circumference,
18| inches. Its parietes are, to a great extent, membranous ;
the parietal bones much expanded ; the forehead projects, the
face is siink in as it were, and is remarkably small compared
to the size of the head. This foetus, contrary to the character
of every production of this nature that I have hitherto seen, was
OF CONOENITE HYDROCEPHALUS. 115
yery fully developed. No reason has been assigned for the
foBtus being diseased, except that, according to the statements of
the mother, she has been subject to much vexation during gesta-
tion, in consequence of the irregular habits of her husband : no
hereditary disposition, as is strikingly manifest among the pro-
geny of some families, could be traced. This is not the only
instance of congenite hydrocephalus that I have seen, arising
under the influence of protracted mental emotions and irregulari-
ties on the part of females during gestation ; and I presume it
must be familiar to the profession, that a diseased offspring is not
unfrequently produced under such circumstances. ^
Edinburgh, 4 Picardy Place, 20th May 1844.
Observations on Dr CamphdVa Paper on Congenite Syphilis, in
the First Number of this Journal. By W. Acton, Esq.,
of Queen Anne Street, Cavendish Square, London.
In my work on venereal diseases, I ventured to call in question
the truth of several ancient dogmas held in great veneration by
accoucheurs of the last century, and which I was inclined to
believe were admitted on too slight grounds by some even in
the year 1840. In the last number of the Northern Journal I
find Dr Campbell somewhat indignant at my questioning these
opinions, which he states ** men of experience, who have been
engaged in pra>ctice half a century or more, maintain to be true.''
On this occasion I purpose stating the points of difference
between Dr Campbell and myself. I believe that accoucheurs
are in error in attributing solely to syphilis ihe occurrence of
abortion about the seventh month, and my reasons are the fol-
lowing : —
1st, In the wards of hospitals devoted to venereal female
patients, labouring under secondary symptoms, abortions are not
more frequently observed at the seventh month than at any other
period; 2dly, These females, in spite of all moral and physical
impression, frequently carry their children to the full period ; and
at the time of birth we meet with the in&nt quite healthy, or only
sickening some weeks after. Such being the natural course of
syphilis when observed on a large scale, I have hesitated in con-
cluding that syphilis produces abortion at the seventh month, or
11^ OBSERVATIONS ON DR CAMPBBLL's PAPER
that the circtuostance oi a diild being boj*ii deadt)r putrid is of
itsdf of any value in the diagnoMS.
Dr Campbell, on the contrary, is an inij^iidit believer in tho
opinion, that when women miscarry abolit the seventh month, and
the child is putrid, we must look to syphilis as the caxfise, and
that a 'cure will be effected by giving mercury to both parents :
the t*eason he assigns for this belief is, hiving witne$»ed the oc-
currence very fre<|uently ; and he gives the two folio wibg cases
in support of his opinion :—
A physician contracted ifhat he believed to be a chancre ;
six months* after he married ; three children were successively
prematurely born ; the first lived only a few hours ; the second
' infant was born between the sixth and seventh month, and lived
eight hours ; the third labour came on in the seventh month,
the foetus dead and decomposed ; no trace of syphilis was ob-
served in either parent ; the father and mother were salivated,
and the next child was born vigorous and free from any syphi-
litic taint.
2d Co^e.^^-^Seventeen years previous to marriage, a gentleman
suffered from syphilis, which he was assured was cured, although
-an impresision remained on his part that the disease had not been
completely removed ; both parents were apparently iA perfect
health ; the first child was bom in the early part of the eighth
ihonth of gestation, was delicate, and lived eleven days ; the
iseccmd birth haj^ened in the seventh month, the infant survived
only an hour and a half; the third delivery occurred in the dxth
month, when a foetus much decomposed was produced; the
husband and wife were salivated, and a living healthy small
female foet^is was born at the close of the eighth month. — Having
related these two cases, Dr Campbell criticizes my opinions^ and
«tates» 1st, That information derived from venereal hospitals is,
to say the least, questionable ; 2d, That my field for observaitibn
was far too limited, considering that, on an average, not morfe
than sil prostitutes in one thousand conceived in the course of
one year, according to the investigations of Duchatelet ; and, 3d,
That <^inions based on such dati cannot be put in competition
with the experience of men who have be«i half a bentury or
more engaged in practice.
The reader inust observe^ that if Dr Campbell admits syphilis
as the cause of abortion in the above-cited cases, he will be
obliged to believe that two parents, neither of whom have had
secondary symptoms, but enjoy excellent health, will prodtioe
ON CONOBNITE «YPHILIfi. 117
not syphilitic childr^i in the sense usually understood by authors,
but infants that present no recognised syphilitic symptom^ ualeas
preiliature confinement or d. putrid foetus be consider^ as such ;
thus excluding all other causes of abortion, and reoogniaing as
the cause a chancre without any of its attendant seiqUelfle.
In the second case, he must believe that chancre, unattended
by secondary symptoms, will, after seyenteeti years^ show itself
in the child, not in the ordinary forms, but in that whkh eaO-
coucheurs affirm is syphilis, consisting in the death <^ the foetus
and pr^nature confinement. This doctrine will> I thiuk^ be at
once denied by all practitioners who have idlowed th^ patients
to marry, and obserred the healthy oSispriDg of those who in
early life contracted chancres not followed by aeeondary syn^
toms. In reply to Dr Campbell's first objection to my opinions,
I must repeat, that a large number of pregnaiit womeu ^^re
nnder my care at the yenereal hospitals in Paris, but that / did
not observe this liability to abortion during the seventh month.
Dr Campbell's statement, on the authority of Duchatelet, that
only six prostitutes in a thousand conceived in the course of one
year, appeared so much at variance with what I had witnessed,
that I rkerred to his book, and find, as I expected, that Dr
Campbell has completely misunderstood the French author, who,
at the commencement of the chapter (De la F^ndit^ chez les
Prostitu^), says, '* En resumant toutes les r^ponses qui m'ont
^t6 faites, et ce que j'ai trouv^ dans qudqties livres anciens et
modemes, j'ai du tirer cette conclusion, que mille prosiitui^
foumissent k peine six accouchemente/^ dans la courant d'une
annde ;" which I should translate as follows : " Judging from thte
answers I have received, and what I have found in soTne ancient
and modem works, I ought to draw this conclusion, that a thou-
sand prostitutes scarcely furnish six aceatichements during the
course of the year." He, however, in the next line goes oh to
say that, not satisfied with these data, he made further personal
investigations ; and at page 233 he gives a table to show that the
acconchements which take place in the hospitals are on an average
51^, and a few lines farther on he augments it to 63^ ; at page
241 he adds, '' tout semble done prouver que les prostitu^ sont
plus aptes k la ft^ndation qu'on no Ta era jusqu^itei." I hop^,
then, Dr Campbell will uow give me credit for having observed
* I have marked the word aecouehemenU in the text, as weU as quglquet, and
condade that Dr CampbeU is weU aware that the French word is not rendered into
English by conceived.
118 OBSERVATIONS ON SR CAMPBELL'S PAPER
on a larger scale than this misquotation would lead his readers
to suppose.*
If I understand Dr Campbell's third objection to my opinion,
it is, that none of his juniors ought to dispute his opinion unless
he can back it with the experience of half a century. With all
deference to the doctor's years, I must, however, remind him that,
in these sceptical days, a host of things (the truth of which was
formerly never doubted) are now held in disbeUef ; that a stem
array of facts and figures, with strict observation of the ordinary
course of disease, is now required to defend an old doctrine or
support a new opinion; and that the heads of the profession
must condescend, like their juniors, to employ these means, and
not only count their facts and opinions, but weigh them.
46^ Queen Anke Street, Cavekdish Square,
London, May 1844.
NOTE BY THE EDITORS.
Though we are determined, as far as possible, to prevent this
Journal from becoming a field for acrimonious personal contro-
versy, we are equally resolved that no one shall have just cause
to think himself aggrieved by our articles, or those of our con-
tributors, without having ample opportunity of setting himself
right with our readers. We have therefore published Dr
Acton's answer to some passages in Dr Campbell's paper, in our
first number, on Congenite Syphilis. We observe that Dr Camp-
bell did expressly refer to Dr Acton as one of those who maan-
tained the opinions against which his paper was directed ; yet
in doing so, we consider Dr Campbell as having paid a compli-
ment to Dr Acton's recent work, since that was singled out as
one of the works of reputation in which such opinions were
entertained. And we remark nothing in Dr C.'s article, in
reference to Dr Acton, which can make us regret its having
obtained our imprimatur without erasure; neither do we
discover in Dr Acton's answer any deviation from that gentle-
manlike style in which scientific controversy should be carried
on between one member of a liberal profession and another.
On the present occasion we have no intention of becoming
partisans either of the one opinion or of the other ; but since our
* See Note by the Editon.
ON CONGBNITE SYPHILIS. 119
two contributors are at yariance in regard to the support af-
forded by a particular work to their respective sentiments, we
have deemed it our duty to consult that work. If any one will
take the trouble to read the whole chapter in Duchatelet's
work, "De la F^condit^ chez les Prostitutes," concerning
which these two gentlemen are at variance, and certain passages
of which each somewhat hastily interprets in accordance with
his own views, it will be found that the purpose of it is to show
that prostitutes fail to add to the population, not because they
do not conceive often, but because, after conception, abortions are
frequent at all periods of gestation, and that, when carried to
the period of viability, the infants almost uniformly die. So
iiELr Duchatelet's statement is favourable to Dr Campbell's
object. But it is plain that the passage which Dr Campbell
cites from Duchatelet does not comprise his final opinion on the
subject of the proportion of deliveries in a given number of
prostitutes, but only that which the evidence first considered
should have led him to adopt, and that he goes on to extract
from various additional documents a new conclusion, — ^not, as
Dr Acton seems to state in the above reply, at the rate of 51^ and
63^ deliveries for every 1000 prostitutes, but at that rate annu-
ally on the whole number of prostitutes in Paris ; or his final conclu-
sion is, that, taking the returns for 1832, there being from eight
to ten annual deliveries not included in the above rate, there
were in all 76 deliveries, or 21 in every 1000 of this part of the
population. We here correct a material error in this chapter —
57 being put for 75 — the only figure, it is plain, which, out of
3558, the estimated number of prostitutes in 1832, will give 21
in the 1000. The whole chapter, indeed, is perplexing. With
the following quotation, which gives the substance of Duchatelet's
views on this subject, we leave our two friends to debate the rest of
the question, as they seem inclined to do, in an amicable manner.
" Tout semble done prouver que les prostituees sent plus aptes
k la fecondation qu'on ne Pa cru jusqu'ici ; qu'il faut, pour cette
fecondation ait lieu, une reunion de circonstances et, pour ainsi
dire, le concours de la volonte et du laisser aller de la fiUe,
veritable etat intellectuel et moral etranger a I'exercise habituel
de son metier ; que si les filles publiques amfenent rarement leur
grossesse au terme ordinaire, c'est qu'elles avortent presque ton-
jours, soit que ces avortements aient lieu par des manceuvres crim-
melles, soit qu'il faille les attribuer k I'exercise de leur mdtier."*
* Parent Duchatelet, i. 241.
120 POISONING BT THE LEAVES OF ACONITE.
Case o/JDecUh by Pois&ning with the Leaivea of Aconite or Monh^
hooiij passed off in Jest for Parsley. By Alex. Ramsay,
Sui^eoB, Broughty Ferry. Communicated by Db Webster,
Physieian to the Royal Infirmary, Dundee.
On Friday the 19th April 1844, I receired a message to ex-
amine the body of Hanton, aged fourteen years, who
had died suddenly during the afternoon. On inquiry I ascer-
tained that, on passing a garden in the parish of Murroes, about
11 A.M., he looked oy^ the wall and asked a young man in
the garden '*if he would giYO him some parsley ;" to which it
was answered, that he would get some new parsley, which was
much better than the .old kind. The young man accordingly
gaYe Hanton a handful of green leaYCS, of which he ate some.
When Mrs Hanton returned to dinner from her field lal)our,
she found her son complaining of burning sensation in the
lOQiith, throat, and stomach, and Ycry sidk. About one o'clock
his mother gaYe him a glass of whisky, thinking that this *^ cure
for eYcry ill" would relicYe these symptoms. After getting the
whisky he went to bed. His mother, thinking he would be well
in a few minutes, left him alone in the house, and went to her
work. Shortly after this, Hanton got up and went to a black-
smith's shop across the road, where he took a fit and fell on the
ground. This at the tim^ caused no alarm, as the boy smelt of
whisky, and it was belioYed he was intoxicated. On his re-
coYcring he found his way back to the house ; and at six p. m.,
when his mother returned from her work, she found him lying
across the bed, with his hands in his pockets, dead and stiffening.
The floor of the room was wet with fluid, which he had ap-
parently Yomited. While in the house I was shown some of the
leaYCs of the plant from which the boy had eaten, which seemed
to be the aconitum neomontanum.* I gaYe no decided opinion as
to the caii3e of death, but, in order to allay all surmisings and
suppositiims, recommended that the body should be opened for
examination next day, to which the friends agreed ; and I re-
quested the kindness of Dr Webster of Dundee to assist me in
the examination.
The following are the appearances on dissection twenty hours
• We have not yet been able to ascertain on what authority the plant was pro-
nounced to be the aconitum neomontanum, which is a variety of the acanitum
commarum of Lixrasus. — Ehjtobs.
POISONING BT THE LSATBS O^F ACONITE. fiHJ
after death. Externallj, the body was plump, and indicated the
preyious enjoyment of health ; the countenance was pale, and
sugillation had commenced posteriorly. On laying back the
integuments oyer the oranhiiD> there was slight ecchymoeds over
the occipital ridge, as if from a blow (which might hare been
caused by the fall in the SHB^h's shop) ; and on remoying the cal-
yarium, the whole blood-yessels within the head were found
enormdusly distend^ yrith dark-colcmred fluid blood, upwardti^
of a poimd of which escaped from the i^uU and spinal tmtkl.
The braiii was of natural consistence, but the y^entriekfi^ e&a-
tadaed a consid&rable^ qus^ettky cf serum. The hmg» were
healthy and not congested ; the heart also was normal, but con-
taiaed no Mood. The stomach was oompletely empty, with a
deep inflammatory blush oyer its whole internal surface, and
here and there patches of a darker colour. We were not al-
lowed to carry the dissection farther. None of the fluid ejected
iva» pfeserred. Spechnens of the plant were, prior to this iisne,
to be found in e^evy garden in the neighboarfaeod ; but such ^M-
the anxiety to haye it remoyed out of sight, i^t it irould now
be c^cult to procure a plant for ornament or use.
It i» impossible te ascertain the esact quantity of the lMte»
eaten in this case ; but i^e probalnfity is that, mistaken for
parsley, ft was considerable. His death appears to have been
caused by the apoplectic staite of the brain, probaMy endkig in-
asphyxia. The administration of the whisky was most injudicious,
and taided without doubt to accelerate the fatal event. Pro-
haMy, had Ueeding been resorted to early aiod freely, the result^
might haye been different. Be this as it may, the case fdly bears-
(^ot the remarks of former writers as to the highly dang^roffil'
nature ef the aconite. I am aware that at this moment it is
exdtiBg considerable attention as a remecKal agent in rheumatic
aad neun^e affections, and I doubt not, when ju^ciously ad-
diinidtered, it may proye a useful and powerful remedy. But
a ^ug of such power wiU require yery great eare in administra-'
tion, an^ rnxnute obseryaition of ite effects, before it can wMb
safety be recosunended to incEseriminate adoption in general
practice. I may remark, tl^t the plant itself oould not welt be
mistake^ for parsley ; but that the deeply cut leaves, after being
detached firem the stem, moght mislead tiie inexperienced.
Moreoyer, it is some minutes after chewing it b€<9r^ ife bumingf
tendency BHOHfests itself.
Q
122 DISEASES OF THE SKIN.
Part IL— REVIEWS.
A Practical and Theoretical Treatise en the Diagnosis, Patho^
logy, and Treatment of Diseases of the Skin; arranged
according to a Natural System of Clasdfication, and preceded
by an Outline of the Anatomy and Physiology of the Skin,
By Erasmus Wiuson, Consulting Surgeon to the St Pancras
Infirmary, London, &c. 8vo, pp. 440. London, 1842,
Churchill.
It is remarked by Dr Latham, that one reason why surgery is
more popular than medicine is its being easier ; and he farther
explains his meaning by showing that this comparative easiness
depends on our abiUty to examine directly the diseases which it
embraces. If this be true, of all the diseases which £sdl under
the notice of the physician, those of the skin ought to be at once
the easiest and the greatest favourites. There are none per-
haps more easily recognised, none more frequently manifested,
none more annoying to the patient, none which, if successfully
treated, confer greater credit on the physician. And yet, are
not too many of them the opprobria of medicine? Are they
taught in general in our systematic courses ? Are they watched,
as they should be, by the students in our hospitals ? Is the treat-
ment of the vast majority of them founded on any thing better
than empiricism ? And yet these diseases have been studied ;
successful attempts have been made to systematize them ; the
classification of Willan is stiU held up as one of the most won-
derful examples of method applied to medicine. We have our
tables constructed, our classes, our orders, our genera, our
species, with all their essential characters regularly and determin-
edly settled ; can any thing be more beautiful or more useful ?
It may be heresy ; but we cannot help thinking that this classi-
fica;tion has done much to retard the progress of that branch of
pathology. It has bound and fettered the advance of know-
ledge by conventional forms ; it has supplied us with systems,
instead of facts ; it has abstracted, without generalizing ; it has
presented us with the form of knowledge, without the reaUty ;
DISEASES OF THE SKIN. 123
it has pretended simplicity, where it has created confusion. We
are therefore prepared to welcome any work which proposes to
break through these trammels, to destroy these unnatural dis-
tinctions, and to present us with a lucid arrangement, or, better
still, with a lucid description without any arrangement, of the
multifarious diseases to which the skin is subject. Mr Wilson
proposes to himself the former of these tasks. Comparing the
system of Willan to the Linnssan system of botany, he comes
forward, the Jussieu of dermatology. In his own words —
^ The thought occurred to me that the study of the diseases of the skm
might be much simplified, and consequently facilitated, by the creation of
a system which should embrace all the adyantages offered by the natural
system, while it retai^ed the benefits derivable from the artificial system.
It was this thought that gave origin to the system which I have endea-
Youred to illustrate in the following pages, and for which I have assumed the
appellation of— Natural System of Diseases of the Skin." (Pre&ce, p. 9.)
Our author seems to have imagined that he was the first to
premise an accurate history of the organization of the skin to
the study of its diseases, which, however, is not the case. The
work of Lorry (Tractatus de Morbis Cutaneis, Parisiis, 1777)
goes very minutely into the nature and structure of the skin,
and these very necessary inquiries have imparted a spirit and a
character to that work which raise it to a high place among
treatises on this subject. To Mr Wilson, however, certainly
belongs the merit of first resting a classification on the basis of
anatomy and physiology, and if the study of these diseases is
really to be promoted by such means, we must award to our
author the title of a reformer ; which, in many respects, he de-
serves as certainly as he has ambitiously claimed it for himself
in his somewhat affected preface. We are not sure that the
classification of Mr Wilson will find even the favour which it
deserves. Scientific men are not now so eager to systematize as
they were half a century ago ; disliking also new names for old
thmgs, they will rather start at being told that ephelis is a " dis-
order of the chromatogenous function," and will perhaps under-
estimate the utility of calling a pustule a " suppurative inflam-
mation of the dermis."* Some of our brethren also, who, to
borrow an expression of Sir Astley Cooper's, " exhibit the snow
* The word <' dermis " occurs repeatedlj in this boolc We woDder that a scholar
like Mr Wilson should employ it ; we have long known it as a sort of coekneyism
of the London schools ; but we thought it had been confined to the slang of the
dissecting room. There is assuredly no such word in the technology of anatomical
sdenoe.
IM J>I$SAI&E^ OF THE SKIN.
QB, the topi ^q{ ibe mouBtfu^/' will perbapft eio^oflaiii of the
doffw^ism with wbioh JMbr Wikoa m»intftiTm o^vt$w apiiuoDB
reiQkoned hfareticaly and may be inioliiied to d^v^eaxd. proof for
Siom^ of Jiift assertions. For example^ whw he mforma us th^^
.seabjj^s is iKyu<iri<jMy produced by ih» iifik^iiOAQCij i|t is not s«ffir
dent .to add, ''there is no part of th^ pathology of cutaaeoua
disacuiea^ of the truth of w^oh I feei bdtt^r satisfied* th^^ of
this.;" and mstead of eensuring M. GriBL^ for stopiHng Bhort
when-fsfits eeasi^d to snppoFt him, and^ 9^ Mr Wilson ee^jM^es^es
it^ *' faltering when aboiit to oonchide ibe race/' it WAidd have
I^een better bad hd hin^elf ejc^iieised a simils^ cauti^n^ It is
imahe tells ns, '' I am thovougbly Gooviaced, aad m long aa I
possess fhut conviction shall erer continne to mgintaiH, that
acarup is the sole and oidy cause of scalnes/' This is all right;
b]«it we ^ugbt surely to have been told on wbat^ tb^se decided
convictions rest. We have no prepossession either way, and
might possibly be convinced by the same reasonixig which has
made our author so decided, provided only it were furnished to
us. But, after all, this dispute, like many others, is chiefly about
words, for Mr W. goes on to say, that " every eruption, how-
ever acuminated and well de&md its vesicles, if it be deficient
of the living cause, is not scabies." (Preface, p. xvi.) This is
of course just assuming what he was required to prove; for if
Mr W. is determined to exclude from itch all those cases ip
which the acarus is absent, no matter how characteristic may be
the eruption, it would be of course absurd to argue with hijn
that the insect is not present in every case. But he ought cer-
tainly to have given us a name for those cases which w^ should
be thus obliged to exclude. Another instance of the same posi-
tive assertion, " unsubstantiated by any proof," occurs in refereiwe
to the eruptive fevers, which our aulior believes '* are diseases
r originating in the same morbid contagion, the differences between
them depending on modification, either of the physical or of the
vital conditions of the system by whixjh the contagion is received."
(Preface, p. 13.)
But we have really no wish to quarrel with a book presenting
so maQy excellencies ; and if Mr Wilson has failed to add any
thing very novel to our knowledge of cut;3,fieous diseases, he has
tixe high merit of simplifying that knowledge, and of having
ooUected into a very degant volume the most valuable facts
which the science presents.
The diseases are divided into four classes, according as they
PiaSAS^S O^ THJe SKiN. 1J26
9Beeb the dpn, tibe /»udoripi^oi}a ^ndsi ^ i^bMeowi i^^ei^
or the hsm md bair'^folli^lea ; i^d the ftrst «hlt]^r ioAroduQ^
ns to the miatomy aad physiology of th^e p^krtft. .!« ti^
<^pt«r, Mr Wilson appears to adyaipiitag^. :He ia ^id^% ^ja
aecmiplished and sciantific anatomist* and th^ jnmi^ »t}«^ cif
the tissues appears to have engaged much of ]m i^Atioiv Ia
bis dc^ription pf tbe akin and epideriQis, w^ do not find much
th^tis ftovel. Thd mode of reprodfictioin and growtb of Ib^
latl^ is amply mi briefly explained. J.hie pigi&i9Pt q{ the
jikin, the sudoriparous a^d sebaceous glanda» and the filmmiii
e<»Qpo»tioQ (rf th^ir aeeretions, are ably and fi«Qpii»^y d04«ntt>ed.
In (bussing the subjeot of perapko^tion, the skvi^r 9iMm to
ito impiQ^rtainoe in health, and eite^ the e^p€flfkn^i# of MM.
Foiarcattlt, Beoqu^rel and Breschet, of which be give* ^M-
lowmg account : —
^ Tb» i^eent ai^erimento of M. Fonreault* thvov 09i«i^ei)shto IjigM on
the jmpoTtWioe ito hoolUi of the seereting fonetjon of "the idcb. The T^
«ilt»of t^e obwxv^atioQS made by this g^nUesumgo to abow, thAl^ if th^
cataneous transpiration of an animal be wbolly j^ir^vented by fxk^fijfm of an
impermeable covering, the animal will die in a short space of time, appar-
^tly in a state of asphyxia. Becquerel and Breeohet, pursuing tJieir
expenments on animal temperature, conoeived, that if tbey e<mld piw^^mt
truispimtion by the skin, they should induce internal fever ; the contraij,
however, was the fact. After the application of a thick layer of vamisn
upon the skin of a rabbit, and adjusting their thermo-electric needles, they
found the temperature of the deep musdes^ in the course of ha}f an houf,
to be reduced from 38 to 32 ; in another haLf-hour, to^^*^ ; and i^ a thii)d
half-hour, it stood at only 3 degrees above the temperatuore of the atmo>
sphere, 17 ; so that, in the course of an hour and a half, the temperature of
the animal had &llen eighteen degrees, and the creature died.*' P. 19.
The second chapter is devoted tp the consideration of tho.se
diseases to ^hich the name of congestive inflammation of the
dermis. is give^. These are divided into those with and tho^e
without specific constitutional symptoms. The former compre-
hend the eruptive fevers, the latter, erysipelas, urticaria, roseola,
erythema. We shall not notice here the eruptive fevers, but ^t
once pass on to those diseases which are really entitled to be re-
garded as affections of the skin. We are obliged to quarrel with
Mr W„ at the very outset of his excellent article on erysipelas,
for a fault of the same character as that which we have already
reprehended. In the definition of the disease, the fever is cba-
rapterized as " contagious and infectious.'* We have no wish
" ^i ji, ■ ^ Ji J » > ■ 1 u . ■ !■ - ■ ■■■ ■ . ........ — r.j . ■ * • I
* £;i;^|]|iaAteur M^dicAle^ QcU 1841,
126 DISEASES OF THE SKIN.
to discuss this disputed question — few are inclined now, we be-
lieve, to agree with Mr Wilson — nor are we disposed to attach
much importance to the experiment of Williams or the case of
Costallat, but would only inquire. Is the infectious and contagious
nature of the fever sufficiently established to make it the ground-
work of a definition ?
The treatment of erysipelas is ably discussed. The mind of
our author is of too philosophical a character to allow him to
become the advocate of any exclusive system ; and, while he
admits the applicability in certain cases of the stimulant plan of
treatment, so confidently recommended by Williams for all cases,
he does not deny the necessity of resorting to blood-letting when
the state of the circulatory system warrants its employment. The
indiscriminate advisers of antiphlogistic treatment would do well
to consider the following excellent caution : —
*^ Under all circumstances, it must be borne in mind that ery^pelas is a
disease of reduced powers, and, consequently, so soon as the artificial ex-
citement produced by the fever shall have passed away, our eflPorts must be
directed to the restoration of the tone of the system."
Mr Listen has drawn our attention to the &ct, that the symp-
toms of increased vascular action may arise from constitutional
irritation ; and thus, instead of being ameliorated, may be in-
creased by venesection. With regard to local treatment, eva-
porating lotions, warm fomentations, or water-dressing — ^the tem-
perature to be determined by the feelings of the patient — are
recommended. We wish our author had placed some limitations
on this treatment, for we cannot help concurring in the opinion
of Mr listen, that the *' use of spirituous and evaporating lotions
is fraught with the utmost danger ; for their direct tendency is
to produce metastasis, and if that be to an internal organ of im-
portance, the result is too generally fatal." The treatment, so
fashionable at present, of mercurial inunction, is not alluded to ;
and we think the experiments of Rayer fully justify its being
discarded as a remedial means, though we are in the habit of
keeping the affected part smeared with hog*s lard, from the
relief which its application appears to afford to the patient.
Puncture is recommended where there is much congestion of the
vessels of the skin, and incisions where there is deep-seated sup-
puration. This, we think, is dealing properly with the disputed
question of puncture or incision. It has always appeared to us
that these were resorted to for different objects ; the one, — ^punc-
ture, serving to relieve vascular congestion, or even, from the
DISEASES or THE SKIN. 127
free intercommunication between the cells of the ceUular mem«
brane, to give escape to acoumalations of fluid ; the other, inci-
sion, being imperatiyely demanded whereyer there are deep-
seated accumulations of pus, or sloughing of the cellular tissue.
The actual condition of the parts must in every case be our guide.
We are glad'to observe that Mr Wilson follows Mr Listen in
recommending the extracts of aconite and belladonna in this affec-
tion. We have seen great abatement of the febrile symptoms, with
manifest reUef to the local uneasiness, follow their employment.
The remaining diseases in this class need not detain us
long. We regret that Mr Wilson has not included in his
description of erythema that singular epidemic variety of it
which occurred in Paris in 1828, and to which the name of
acrodinia was given. We were a little startled with one of the
remedies recommended for the treatment of erythema, — ^the
friction of the skin with croton-oil liniment. We have been
accustomed to regard the pustular affections of the skin as usually
more severe than the slighter exanthemata, and, to apply to the
vocabulary of Mr Wilson, would be loath to engraft a suppura-
tive upon a congestive inflammation of the dermis.
The fourth chapter of Mr Wilson's book is devoted to the
consideration of those inflammations of the skin which are cha-
racterized by effusion of a serous fluid upon its surface, and em-
braces the orders Bullae and Vesiculsd of Willan. This group is
still further dividedinto sthenic and asthenic, theformer embracing
the bullous, the latter the vesicular diseases. We are not disposed
to acquiesce altogether in this arrangement. The separation be-
tween bullous and vesicular diseases is certainly unnatural ; and we
also doubt very much whether we are warranted in regarding
all the cases where blebs occur as asthenic. The disease — acute
pemphigus for example — though rare, is certainly attended
with fever of the sthenic type. Nor does it, like the other
varieties of the same disease, usually occur in individuals of a
broken-down constitution.
Our author properly follows Rayer in classing pemphigus
and pompholyx together, and placing rupia beside them ; from
which natural position Willan had removed it, forcing it into the
class of vesiculad. He removes the miliary eruptions from ihe
vesicular diseases, placmg them under disorders of the sudori-
parous system. Hydrargyria he considers identical with
eczema, except in its cause ; and scabies is placed in a class b j
itself, as a disease invariably produced by parasitic animalcules.
Wd do not tlndt there its tfiUcb of novelty in the i^effiedies 6(
Mr Wflson in these &easeE^ We are sufpi^sed ^th the
rii^i notice tr hicb that setere and dangerous affection receives,
to which the name of rupia escharotica or pemphigns gangrsen^
oisus has heen given. It is tr ne thia dkease seems indigenous to
Iceland only ; and by far the best description which we have' of
it is by Dr Stok^ senior. (Dnb. Med. and Phys. Essays, vol. i.)
Thi^paper, however, seems^to have escaped thenotice of Mr Wilson,
as ttolhing is said by Mm of the scroftdaria ointment, which Dr
Stokes found so nseftd. tJnder the same head, we think, might
be included the fatal sloughing of the pudendum described by
Mr Kindw Wood of Manchester. In this chapter a foot-note
informs us^ that M. Gmby, whose researches we shaH have
aecasiGHQ to speak of in connexion with favus, has discovered a
plant in the bulIsB <rf nq)ia. We observe from a recent report
ot the French Academy of Sciences, that the same distinguished
observer has found (O^yptogamous vegetations in the variety c^
herpes, termed " tonsurans " by M. Cazenave.
In reference to sudamina, Mr Wilson adopts the decided
opinion of Batemsm, that tbey invariably proceed from the effect
of a stimulating regimen and a confined atmosphere. We suspect
this is extreme, and ^ould be inclined rather to coin<Me with
the views of Professor Schoenlein, which he thus expresses in a
lectore recently pubUshed : —
*^ i have also to observe, that the eraption of miliaria frequently takes
place in spite of a cooling antiphlogistic treatment, as I have more than once
seen at Wurzbnrg, where it often appeared on the second day of the complaint,
in iqpfte of blood-letttng. The physiciaiis in Verona and Bergsano have made
the same remaife. The i^pearance of miliaria must therefore not be made
an immediate subject of reproach to the physician, for, by in<^uiring at those
places where miliaria has epidemically reigned with fatal effect, we find
that the exanthema appears in spite of all medical care. If a physician finds
no eraption of miliaria in the place where he practises, he should be thank-
ful for ity and not forge weapons on that account against his colleagues.
Nor can we be reproached with having violently suppressed the diarrhoea^
and having thereby called forth the miliaria." — Lancet^ iVb. 7.
In the fifth cha|)ter of Mr Wilson's book, undier the ikh
" Suppurative Inflammation of the Dermis,*' are comprehendcid
i^ pUBttlar diseases, which are restricted t0 impetigo and
ecthyma^ Oar auibor very ptoperly follows the French school
in adbolisUng the genus porrigo, and transfers variola to th4'
eruptive fisversl Favus i» regarded as a disease of the hair*
DISEASES OF THE SKIN. 129
follicles, and sycosis as an inflammation of the sebaceous glands.
There does not appeal* much that is novel in these chapters.
In the treatment of that exceedingly troublesome aflfection
"impetigo of the scalp/' the absolute necessity of cleanliness is
strongly enforced; and the following incident, which, as the
author says, '' speaks volumes with regard to the treatment of
this disease,*' is recounted : —
^ I had often occanon to obserre with regret the utter useleaEnest of all
medicinal applications in the treatment of these cases in the St Pancras In-
fiimary, where numerous children are annually affected, and several are
constantly in the sick wards. This want of success originated in the absence
of proper nurses to carry out the directions of the suigeon. It was in vain
that the necessity of cleanliness was urged upon them ; they received little
for their labours, and were not disposed to engage in a most disagreeable
duty on philantlux>pic grounds alone. Under such circumstances, the phar-
macopoeia was exhausted of its specifics^ but no advantages resulted. Things
were in this state, and I had little hope of change, when, to my surprise
and delight, I perceived the number of patients suddenly diniinish, and
those who remained looked cheerful and better in health. I inquired into
the cause of this change, when I learned that a new nurse had been appointed
to the charge of the children, and that she had set her shoulder vigorously
to the wheel of these obstinate eruptions, and had turned out sevend cures.
Upon asking her how she proceeded, she of course looked mysterioufl^ but
I quieted her fears of my perquisitions, by telling her that it was not her
secret that I sought, that my object was simply to approve of her proceed-
ing, and to urge her to its continuance. She said in reply, that her treat-
ment consisted in the application of a remedy derived from a 'subscription'
giren to her mother by Sir Astley Cooper ; that this legendary specific was
a coarse admixture of ' butter and pepper.' For sound philosophy this
remedy,* in its modus operandi, is worthy of the celebrated name with
which the female Asclepiad had associated it, and I applauded its effects ;
it was an apt illustration of the sympathetic treatment of wounds by
aaomting the wei^n with salves, and swathing it in countless bandages.
Bat I reserved for myself that which my female oolabonrer could not have
oomprehended — ^the perception of the benefit derivable firom the thorough
ablaticMis and rigid deanliness with which the specific was acoompaniedL''
P. 187.
Chapter sixth, under the title of " Depositive Inflammation
of the Dermis/' discusses the order papuIsB of Willan, which is
strictly adhered to ; even Ray er's improvement of oniting stroph-
olns and lichen is not adopted. Mr Wilson believes that
pimples consist essentiall j in an effnsion of plastic lymph into the
tissue of one or more of the papillae of the dermis. There is
nothing in this chapter that need detain us.
In the treatment of the obstinate class of sqaamons diseases,
* '^ A hamhle'mutalkm oi ilMtungaeDtmkm^
ftmcdy leeonmaMlcd ftr fimis**'
190 DISEASES 07 THE SKIN.
to the consideration of which the following chapter is deroted,
we find some valuable remarks. I^nce M. Biett directed at-
tention to the employment of arsenic and tincture of cantharides
in these affections, the j have perhaps been too g^erally resorted
to ; and it is well that those who use them indiseriminatel j should
remember the caution of Rayer, which is quoted by Mr Wilson.
** ' It is undeniable that by means of these active medicines several of the
varieties of psoriasis^ even the most inretemte, have beea eared ; Imt it is
no less certain, that the maj<Hity of the om«8 tiuis aooMiq»lithed have been
but temponay, relapses having oceiuved the foUowii^ ^xing er aoitnmn;
that such relapses are more especially frequoit among the labouring cbMOi
of the community ; and, lastly, that the greater numb<» of eases of paon^sii
inveterata treated by such means have been in nowise amendiM^ akhoug^
the medicines were contbiued for five or six mentlM. I am therefeie of
Opinion, that it is, in genersl, inexpedient to put patients affected with
psoriasis inveterata upon an arsenical course, in the &int hope of deriving
a mere temporary improvement, with the §Ux before our eyes of inducnag
some obstinate derangements of the digestive oigans^ or of permanently in-
Jurmg tile general constitution.* ** P. 290.
Among the local applications recommended in these affections*
we find three remedies which we have not brfore seen noticed
by any British author. Anthrakokali is a chemical compound
of potass and coal, and was introduced by Dr Polya of Pesth,
who gave it internally. Gibert found it fail as an internal
remedy, but succeed well externally as a mild stimulant applica*
jtion ; but he is inclined to prefer the fuligokali, a compound of
soot and potass, prepared in imitation of antfarak(^ali by M.
Deschamps. The following is Mr Wilson's account of the pre-
paration of this remedy : —
'^ As an external application, in the form of ointment^ ft is re0oli:^ive^ deterw
sive, and stimulant. The mode of prepamtion of the compound is the follow-
ing: — ft Caustic potass, 20 parts; soot,100part8; water, q. 8. Boil the mixture
for an hoar ; cool, filter, evaporate, and dry. The fuligokali is obtained in
the form of scales or powder, and must be kept in well-stoppered bottles in
a dry place. A sulphuretted fuligokali is obtained by the following pro-
cess : — ft Soot, 60 parts ; caustic potass, 14 parts ; sulphur, 4 parts. Heat
the sulphur and potass with a little water, and after their sokitMm, add the
soot. Ev^orate, dry, and dose the resulting compound in wellnrtoppered
JMtles, and keep it in a dry place. The ointment used by M. Gibert is
composed of a scruple to half a drachm of the salt to an ounce of lard. In
larger proportion it is highly irritating.** P. 396.
We are also informed that
^ M. Lemery, of Saint Louis, has lately recalled the attention of practi-
tfoners to an old but valuable application in lepiooa afieetioD8*^na]nely,
tor. Fmding, however, that this remedy was objeetlttiaMiis on aooouiit of
DISSASES OV THS SKIN. 131
its eoiofarwid odour, ho liod ifooimo to one of the picdncU of far, 9omenU
mapkihaSney which afibided him the moot saoceflsfiil lesolts. The piepcn-
tioQ ndiich he employs is an ointment^ composed of naphthaline^ two to four
parte ; laid, tluitf pasta. This he applies to the disnsed sIob, on iolda of
ImeD, B^^ and morning. The ointment is highly ttimwlating^ v*^ hw a
powofol ameO, idiieh qoickly passes away. By means of the ni^hthaline
ointment. If. Lemery succeeded in caring e^ht patients out of fourteen, in
frran fire weeks to three months." P. 221.
We are nirpriaed that an author ao Tersant as Mr Wilaon
m medkal fiterature, tuuimst as well as modern^ should not have
noticed, in oonnexion with the treatment of sqnamoas diseases,
a remedy introduced by Dr Burgess, with which we hare sac*
eeeded in improving sereral yerj unpromising cases. The
aflhcted part is exposed to the Tapoor produced by throwing the
following powder on a hot iron : — 'Bt Snlphnris, SiiL ; hyd. sulplu
mb. ^iL ; iodinii,gr. x. The limb maybe continued in the both
team fif te en to twenty nmrates* In the oourse of a day or two
the proportion of iodhie may be increased (Burgess' Translation
efGaBenaTe,p. 209).
In some obstinate cases we haye found the following lotion of
lerrioe: — ^& Greosoti, gtt.xx; ac hydrocyan« med« 3i; aq«r
fontis, 3zii. : M. ft. lotio.
Chapter dghth discusses inflammation of flie cutis, induced
by parasitic animalcules inhabitbo^ the epidermis, which eompre-i
heads scabies alone. We had intended to dispute with Mr
Wilson the propriety of this exduaye view of this subject, bul
fasTo already exceeded our limits so much that we must not at*
tempi it. Those who beheye the disease to be produced ezclu«
BTcfy hj the aearus, will be interested in the following experi-
ments of M. Albin Gras, as to the poison which most readil j
destrojed it : —
* ^Immened in pure water, the aeams was yet alire after tiffee houxs ;
inadkie water it mered leehly at the end of time hours ; in Goulaid soln-
tian it Ured after an hour ; in qUyo oH, almond oil, and castor oil, it sor-
n?ed mote than two hooia. In croton ofl it was lirag after the kqiee of
aa hour, hut dead at the end of four ; in lime-water it waa dead in thiee
foaiteis of an hour ; in yinegar, in twenty minutes ; in alcohol, also in
twen^ minutes ; hut in naphthaline still more quickly ; in a solution of
adphnnt of potas^ it was dicadmtwidw minutes; m ^irit of tntpcnlino
la BiDe BiaBtea ; in a copccptrated solation of hy^iodate of potas% the
acarnseeased to exist in from four to six minutes; in a scdutionof assenieas
aeidit wasdead in four minutes ; in sulphuric ac^ diluted with three parts
water, it died in tinee mramtes ; in pore creosote, «id in eoneentrnted aeift
sadaJkaBiB^itodBathwasinmwdiBte, Fbwed orem^ eat powdend ad-
pbor, the ammakale was £o«md dead the next day; and it rsqiiiied to be
132 DISEASES OF THE SKIN.
exposed to the vapour of buniiog solplmr for dxteen minuteB before it died.' "
P. 247.
Chapter ninth is devoted to those diseases which consist essen-
tially in hypertrophy of the papill» of the cutis. We regret
that our limits will not permit us to extract, as we had intended,
our author's interesting observations on corns, which are well
deserving the attention of the peripatetic sect of practitioners.
Chapter tenth, which includes n»vus and purpura, has dis-
appointed us. A disease so interesting as the latter ought
surely to have claimed more attention from one who professes
himself a reformer in diseases of the skin.
In chapter eleventh, Mr Wilson considers disordered sensibility
of the dermis independent of local disease. Pruritus occupies
the whole chapter.
Chapter twelfth is occupied with the consideration of the
disorders of the chromatogenous functions of the dermis, the
most important of which is albinismus. Under this head we are
surprised to find it asserted that accidental albinismus is only
met with in the natives of Africa. An interesting case is re-
corded by M. Alibert of its occurring in a lady, a native of
France, who became affected at the age of 13.
In the thirteenth chapter, Mr W. considers the diseases of the
sudoriparous glands, the most important of which is " sudatoria,
an excited action of the sudoriparous glands attended with symp-
toms which indicate inflammatory determination." We doubt
very much whether this disease has any better right to be
regarded as a disease of the sudoriparous glands than diabetes.
The succeeding chapter is devoted to diseases of the sebaceoust
glands, under which is included molluscum contagiosum, the
tumours of which Mr W. regards as " normal sebaceous cells,
containing granular matter, filling them more or less completely."
This opinion our readers will at once perceive is directly opposed
to that of Dr Paterson of Leith (Ed. Med. and Surg. Journ.,
vol. Ivi. p. 279), whose views Mr W. combats with some effect.
He is scarcely so successful, however, in his attempt to establish
the non-contagious character of the disease.
Chapter fifteenth embraces the diseases of the hair and hair-fol-
licles ; among which we find that plague of the nursery, favus.
Mr Wilson gives the following account of the recent discoveries
of the nature of the crusts of favus. The interest of these in-
quiries, and the importance attached to them, must be our apology
for rather a long extract.
DISEASES OF THE SKIN. 133
^Pathology. — ^The yellow substance which constitutes the cmsts of
&yu8 has been satisfactorily proven, by recent inyestigation, to be an
oiganic growth of simple structure^ and bearing a marked resemblance to
those inferior members of the vegetable kingdom, denominated mould. The
structure of these crusts appears first to have attracted the attention of
Remak, who had observed, so early as 1836, their composition of ^ fungoid
filaments.' Professor Schoenlein of Zurich next called them to notice in
a paper in Muller's Archiv. for 1839, on the Pathology of the Impetigines,
in which he makes no doubt of the fdngous nature of the substance, and he
illustrates his communication by a rude figure of the appearance which
they presented in his observations. In pursuance of Schoenlein's re-
searches, they were examined by Fuchs and Langenbeck of GrottingeA ;
more recently they have been studied by Dr Gruby of Vienna, who
expresses himself to have been ignorant of the labours of Schoenlein. Dr
Gruby has, moreover, given a clear and lucid description of the growth,
which he regards as a parasitic plant, and has determined it to belong to
the genus mycodermis. The following is an abstract of a paper, &om the
pen of Dr Gruby, on this subject, in Muller's Archiv. for the present year : —
** * The cup-diaped crust of fisivus is situated upon a depression of the
dermis, and is covered by a sheath of epidermis^ which is thickest on its
concave, and thinnest on its convex surface. Immediately within the
epidermis is a thin layer of amorphous substance, composed of minute
molecules ; this layer is dense, of a sulphur-yellow colour, and forms a
capsule, which is in contact by its external surfiice with tlie epidermis,
and by its internal surfiice with a fungous growth. The parasitic growth
is attached by means of its roots to the yellow capsule, while its stem and
branches extend inwards towards the centre of the capsule, and constitute
the whitish gray and porous contents of the crust. The roots and branches
of the mycoderm are smooth, cylindrical, transparent tubuli, which divide
dichotomously from, point to point. The interior of the tubuli is filled
with a granular substance, and divided here and there by transverse septa.
At the ends of the branches are situated the seeds of the plant, which are
of a yellowish white colour, and either collected into an irregular assem-
blage, or disposed in the form of a garland. The diameter of the branches
of the myoodennis is i^xi ^ s^t; o^ & millimetre ; that of the molecules
contained within the tubuli, 19.^99 to j^^^^ mm. ; and that of the seeds,
5^9 ^ lis '°^^^' ^' Gruby has detected seeds in the follicles of the hair,
and impacted in the ducts of the sebaceous glands.'
" To ascertain the degree of contagious power of the mycodermis, Dr
Gruby inoculated various mammiferous animals, birds, reptiles, and insects,
but unsuccessfully ; he was equally unsuccessful in his own person, but
succeeded, after seventy-six attempts, in reproducing the mycodermis in a
cryptogamic plant.
** Mr Busk, in a paper entitled ' Observations on Parasitical Growths on
Living Animals,* in the Microscopic Journal (No. 10), has given an excel-
lent figure of the mycodermis. He represents the branches as consisting of
a series of oblong cells connected by their extremities." Pp. 348, 349.
In the disease mentagra or sycosis, M. Gruby, in September
1842, announced the discovery of similar cryptogamic forma-
tions, which constitute a vegetable sheath round the dermic
portion of each hair. Mr Wilson, however, is more cautious
134 PISBASBS OF THB SKIN.
ihaa aom» of our ottirand-out " HiBtologiats/' in pYmg in to the
theory of the yegetable character of these diseases ; axid r&tj
properly remarks, that, *' however closely these fungous groirdis
may resemble plants, their vegetable nature is very far from
being established/' and concludes with the following very scten^
tific opinion of Dr Carpenter : —
^Dr Curpenter, in his Principles of Physiology (p. 453), q^eakingca
the BAme snbjeci, remaiks — ' It has been assumed that the ofganisation is
vegetable, because it (mycodermis) consists of a mass of cells capable of
extending themselrdi by the ordinary process of multiplication. But it
umst be remembered that the vesicuhur organization is common to animals
as well as to plants, being the only form that manifests itself at an early
period of development in either kingdom, and remaining throughout Ufe in
those parts which have not undei^one a metamorphosis for q^ecial purposes^
Hence, to speak of porrigo favowy or any simiku: disease, as produeed by
the growth of a vegetable within the animal body, appears to tiie author a
very arbitrary assumpticm ; the simple fact being, in regard to this and
many other structures of a low type, that they pieieat the simplest cnr
most general kind of oiganisation*' " P. 350*
In the treatment proposed for this obstinate aflEection there
is nothing novel.
** TreatfMnt.-^T\iQ indications to be fulfilled in the treatment of &vu8
are four in number— namely, 1. To destroy the vitality of the parasitic
growth ; 2. To remore all local causes of irritation ; 3. To remove all
general sources of irritation ; 4. To excite the diseased hair-follicles to
healthy action, and prevent the reproduction of the mycodermis." P. 351.
For fulfilling the first indication, the author recommends
" impregnating the crusts and bathing the scalp with a mode-
rately strong solution of bichloride of mercury ;" and that which
he recommends for the fourth is the tincture of iodine faoraohed
into the scalp three times a-day. This remedy, first introduced
by Dr Graves, has utterly failed in many cases in our hands ;
and we have not succeeded better with that so confidently re-
commended by Mr Wigan (Med. Gazette, Sept. 15, 1843X
Beaufoy's concentrated pyroligneous acid. Mr Wibon alludes
to the great success of the treatment of the brothers Mahon,
axid regrets that their remedies are still kept secret ; but, if M.
Diqyarc (on Cutaneous Diseases of Children) is to be credited,
this is not the case, the following being their method of cure :—
" The hair is first cut short and then removed by emolKent
poultices. The head is now frequently washed with soap and
water, and the inunctions and lotions continued until the scalp is
completely cleaned. When tiik has been effected, the second
stage of the treatment commences, the object of which is to
DISEASES OF THE SKIN. 135
remove ihe hair slowly and wUhautpain from aQ the points of
the scalp oocnpied by the fayns. Every second day the oint-
m^t (No. 1.) is apphed, and its use continued a^KX>rding to tiie
obstinacy of the case. On the intervening days the hair is
combed wi& a fine comb to remove the loose hairs. This mode
of treatment having been eontinued for about a fortnight, a
dqpilatory powder (No. 2.) is sprinkled through the hair once
^week ; and e« the following day the hair is combed, and the
depilatory ointment applied as before. At the end of a month
or six weeks, a more active ointment is employed every day ;
hhd, as the disease gives way, the frictions are made only once
a-wedt, until the redness of the skin has entirely disappeared.''
Although the formula of the remedies employed by the
" Jreres Malum" have been kept secret, yet their composition
has been very nearly ascertained by experiment, and is supposed
to be as follows : — ^No. 1. Slaked lime, 8 scruples ; soda of com-
ffieree, 12 scruples ; lard, 64 scruples. — No. 2. Wood ashes, 64
parts ; pulverized charcoal, 82 paints. — Lotion. Lime-water, 500
parts ; sulphate of soda, 185 parts ; alcohol, 24 parts ; white
soap, 10 parts.
We are much inclined to recommend the removal of the hair
by some depilatory ointment and assiduous combing, accompanied
with frequ^it washing, in the early stage of the disease. When
the more acute symptoms have subsided, the affected parts
Aould be touched every third day with pure creosote, and
covered in the interval with pledgets smeared with an ointment
composed of creosote, gtt.xxx. ; lard, §i. ; or dipped in the
liniment recommended for scaly diseases.
Of the two remaining chapters of Mr Wilson's book, the one
is devoted to syphilitic eruptions, which we have no room at
present to discuss; and the other might with more propriety
have been styled aa appendix, consisting chiefly of additional
observations on subjects treated of in preceding chapters.
From the fiiU account that we have given of this work, and
the numerous extracts with which that is interspersed, our
readers will be able to form for themselves an estimate of its
merits. As far as the fulfilment of the object for which it pro-
fesses to have been written is concerned, we cannot but regard
it as a failure, the changes proposed in the classification consist-
ing chiefly in the nomenclature of the orders and genera. Nor
can we consider such an object worthy either of the talents or
the opp(»*tunities of observation which Mr Wilson undoubtedly
136 ON THE DISEASES OF THE TESTES
possesses. The earnest mind, investigating the pathology of
this interesting class of diseases, will not now be put oflf by the
forms and semblances of knowledge. We require a real grap-
pling with the subject in all its extent. For this task, even in
the work before us, Mr Wilson shows himself qualified. Let
him take the step in advance, and we anticipate a glorious
result, the sign of which will probably be the exploding of his
own and all other existing systems, and the establishment of a
new one on a more extended and firmer basis. Meanwhile, let
us congratulate Mr Wilson on what we must regard merely as
a first instalment, the numerous excellencies of which will require
him to exert himself on future occasions, if he is to fulfil the
expectations which his first volume on this subject has raised.
A Prctcticcd Treatise on the Diseases of the Testes and of the
Spermatic Cord and Scrotum. By T. B. Curling, Lecturer
on Surgery, and Assistant Surgeon to the London Hospital,
Surgeon to the Jews' Hospital, &c.
The work heading this article is one of much merit, and is
written in a very plain, clear, and unpretending style. The
author's object seems to have been, through every page of the
work, as he himself states it was, to endeavour to make it as
practical and as useful as possible. This point he has most
certainly fulfilled. He has, however, done more. He has
endeavoured to explain, as far as the present state of our know-
ledge would permit, the processes by which and the circum-
stances imder which the different diseases connected with the
several tissues which compose the organ under his consideration
are produced and developed. In the treatment of these subjects
he has not forgotten, but on the contrary he has brought some-
what prominently forward, the effect which the character of the
constitution has upon the nature of these diseases, and upon their
onward progress. It is here that the surgeon, who is desirous of
advancing this branch of medicine to a higher state of perfection
than it at present possesses, must labour. It is not by statistics,
though this has done much ; — ^it is not by a mere knowledge of
descriptive and relative anatomy ; — ^it is not by the minute de-
scription of symptoms ; — ^nor is it by the advancing of morbid
anatomy in the direction in which it has, up to this time, almost
AND OF THB SPERMATIC CORD AND SCROTUM, 137
entirely progressed, that surgery is to be really improved. It
is by studying disease in an entirely different method, but still
in connexion with these ; by endeayouring to unravel, analyze,
and make known the nature of disease. To do this, the origin
and progress of disease must be studied at once chemically,
microscopically, and physiologically. We indeed grant that
om* present state of knowledge, in any of these branches, with
the exception of the last, prevents them from being brought, with
any chance of success, except in a few rare instances, to our aid.
Nevertheless, it is not of small importance to be acquainted with
the correct path along which observers ought to proceed ; for
then time, continued labour, unwearied industry, and indomitable
perseverance, are but wanting to carry our undertaking to a
successful issue.
The subjects described or spoken of in the work at present
under our consideration are divided by the author into two
great and distinct classes : — ^mto that which relates to the
healthy structure and the healthy functions of the testes, their
coverings, their ducts, and their vessels ; and into that in which
the diseases of these parts are described, and their treatment
laid down.
The remarks which we propose making on the first portion of
the work, i. e. upon the part which relates to the healthy
anatomy and the healthy functions, shall be confined principally
to a description of the process by means of which the testicle
passes from the abdomen into the scrotum ; as on this point Mr
Curling has indeed thrown great light, for which he deserves no
small credit.
That it was long known, previous to the time of Haller, that
the testes, during the greater part of foetal life, are situated
in the abdomen, is evident from the writings of several of the
older anatomists : this fsict is also shown by Haller himself, as in
his Opuscula Pathologica he refers to the circumstance of the
older anatomists having noticed the abdominal position of the
testicles during foetal life. However, neither they nor Haller
were acquainted with the circumstances on which the change of
situation of the testicles, in the two stages of life, depends. And
what is very curious and well worthy of remark, is, that al-
though John Hunter described, to a certain extent with correct-
ness, the gubemaculum testis, — a part which he had himself
discovered, — still he did not assign to it its proper use, and from
this drcumstance was unable to account, with any degree of
13S ON THB DI&EASE8 OF THB TESTES
eertaintjr, for ihe descest of the testiele. It wss not watil Mr
Gurlifig hftd pnbGdted hb exceedingly beaatifidi and highljr
aeientifie remaito vpoft the scibject, that we possessed m Ihk
eoaatry any correct knowledge aa to the cause ei the (fescent (^
this organ.
We propose here to enter at some length into one or two of
the anatomical questions connected with the descent of the
testicle. This we are induced to do, not only by feeKng- the high
importance of a right miderstanding of the anatomy oi the
descent in a sm*gicaf point of yiew, but also because we have
obseryed that the accounts of this subject m our best works of
anatomy, are either founded on misappi^ension, or so obscurrfy
expressed, that it is impossible for the reader to dscover the
true nature of the descent, particularly in its rda^ns to the
perit(meum.
In Hunter^s Animal Economy is contamed a paper upon the
descent of the testicle, which is distinguished as exhibiting greafc
truth of description, and a rare power of generaE&ng anatomical
fSetcts.
The cremaster muscle (we follow Hunter's account, retainmg;
as far as we can with brevity his own words), has two very
different positions in the foetus and in the adult ; in the former,
it ctgcends^ to the testide, while in the latter, it descends into
the scrotum to the same organ.* This muscle appeara to be
composed of the lower fibres of the obhquus intemus and trans-
rersaKs musdes. The testicles, while in the abdomen, we harei
found to be connected with the scrotnm by means of a structure
which passes from the lower border of the testis to it ; to this
struotore we shall give the name of l^ament or gubemaculum
testis. This Kgament lies before the psoas muscle, but behind
the peritoneum, while within the abdomen, and reaches from the
testis to the groin ; thence it passes directly downwareb into the
scrotum, in the same manner as the spermatic vessels do in the
adult, and is there lost. It is hard to say what is the structure
or composition of this ligament ; it is certainly vascukr and fibrous,
and the fibres run in the direction of the Egament, whidi is
covered by the fibres of the musculus testis, which are placed
immecfiately behind the peritoneum. The testes move down-
* Fcft thi take of deaxneRs and diatinctnesa^ we ahall call the ciemaater musde,
while it ascends within the ahdomen to the testide, musculus testis ; and We shall
erif it cfeoMster mosck when pasting hem the waUs af the abdoMci^ to the teatida^
after ^hot oi|;an k siftuated in the saetoBi ; pitmiaiog at tha laaia tiiae that we
believe them to be, though differentlj situated, the same musde.
AND OF THB SPBBMATW CORD ANJ> SCSOTUM. 139
wards imtU their ^dxtr^mity <iomes into coateuA with tile kwer
part of the abdoiainal pari^tes. That portion of the gubenu^
adnm testig which wa» within tiie abdoBien lies aow ia the
passage from the Abdomen to the scroiiuni, into whidi the testes
are afterwards to be received. As the tenticle pasees out from
the abdomen, it in eome degree inyerts the gWbernaoiiliun testis ;
the external SMr&pe now becoiaii^ tiie internal^ and the internal
the external ; so thai the pmtoneum, instead of covering the
cremaster muscle, is covered by it, aaa4 tiius forsos the tunica
After the testis has got quite tiirongh tiie tend^m of the* ex-
ternal oblique muscle, it easily acqusres its detenakied station,
though it commonly remains for some time by die side of the
penis,* and only by degrees descends to the bottom of the scror
tmn. Wh^i the testis has entirely descended into the scrotum,
its tigament is stiU connected with the scrotum^ and lies under it^
but is shortened and compressed.
In the hedgehog, the testes continne throi:^h life to be lodged
within the abdomen, as in the hiunan foetus ; and are there fas*-
tened by a similar ligament near to Uie groin. In that a.nimal,
ihe lowermost fibres of the internal oUique muscle, which con*>
stitute the cremaster, mount up on the ligament to the lower end
of the testis. Sometimes in the human body, and very often in
sheep, the testes do not descend until late in life, or never at alL
hx the ram, when the testes have descended, the cremaster is «
yery strong muscle, and covecs the tunica vaginalis ; but in the
ram whose testes remain in the abdominal cavity, '^ I find that the
cremaster still exists,'' tiiough it is a weaker musde, and instead
of pasang downwards, it passes upwards, and is lost near to the
testis, hx the humaoi fioitus^ while the testes are in tiie ^cavity
oftheabdomen^ the cremaster is so siMid^ that ^ I cannot Ibwse
it to my awn satisfaction," either turning ixp towards the testis or
tommg down towards the 4Mnx»tum. Yet, from analogy, we may
conclude that it posses up to the testicle ; nnce in the adult we
find it inserted or lost on the lower part of the tunica vagiaalici,
in the same manner as in the adult quadruped.
What is the immediate cause of the descent of the testicles t
It «annot be the eonqpressiTe force of respiration, the testes being
in the scrotum before the child has breathed.
* Professor Owen ttatei, that thli ii the pennanent tituadon of the ttatei fai the
iiaaaiiHiiMH, IB whidi alao^ as te the Inmam fiBtna, at the peiiod above menlioiied,
the tnnicm ^aipiialii commnnicatefl with the abdominal eavitj.
140 ON THB DI6SASE6 OF THE TESTES
Is the testicle pulled down by the musculus testis ? "I
can hardly suppose it, because, if this were the case, I see no
reason why it should not take place in the hedgehog as well as
in other quadrupeds.'** But even if the musculus testis had this
power, it could not bring it lower than the external abdominal
ring.f We have here given a pretty full digest of John Hunter's
paper on the descent of the testicle. We shall immediately show
that these observations correspond almost entirely with those
lately made by Mr Curling.
We first, however, say a few words concerning the opinions held
as to the manner in which the cremaster muscle is formed. These
may be divided into two orders : —
First, On the philosophical and comprehensive idea, that the
cremaster muscle is formed in the same way in the human being
as in the mammalia ; i. e. this muscle is formed at a certain period,
previous to its being required ; and this formation takes place
independently of any accidental circumstance.
Secondly, On the very limited and very unphilosophical notion,
that this muscle is formed accidentally, by the testicle carrying
along with it, while passing through the walls of the abdomen
into the scrotum, a few of the fibres of the internal oblique and
transversalis muscles.
The first opinion was, as far as we know, first stated by John
Hunter, and subsequently adopted by Sir Astley Cooper, who
says, " The cremaster, as far as I can distinguish it in the foetus,
passes upon the gubernaculum to the testis."
The other notion is that held by Cams, Jules Cloquet, and
indeed generally by anatomists. Jules Cloquet says, in speaking
of this subject, " The cremaster does not exist before the period
at which the descent of the testicle takes place ; it is formed in
proportion as this organ, which is drawn down by the guberna-
culum, passes from the abdomen into the scrotum," He again
says, " By drawing down the gubernaculum, we simulate, in
some degree, the natural descent of the testicle, and form an
artificial cremaster," There is a reach of thought in the former
* Here we have a good illustration of the danger under which we lie of either
falling into error, or of allowing truth to escape us, when drawing conclusions from
apparently similar data, in consequence of the requisite knowledge not having been
obtained. This was principally the cause why John Hunter did not discover the
use of the gubernaculum.
f We shall immediately point out that John Hunter erred in making this state,
ment.
AND OF THE SPERMATIC CORD AND SCROTUM. 141
view which contrasts well with the narrow and crade ex-
planation of the latter.
Haying now shortly stated the opinions held as to the mode by
which the cremaster muscle is formed, we shall proceed to give
a pretty full analysis of Mr Curling's views of the anatomical com-
position of the gubernaculum testis, its insertions, and its uses.*
The gubernaculum testis Mr Curling describes as a soft, solid,
projecting body, which is connected above with the inferior ex-
tremity of the testicle, the lower end of the epididymis, and the
coimnencement of the vas deferens. The central part, which forms
the bulk of the gubernaculum, is composed of a soft, transparent,
distensible, gelatinous tissue — ^primitive cellular tissue. This
central mass is surrounded by a layer of well-developed muscular
fibres, which present under the microscope the striated ap-
pearance peculiar to animal muscular fibre. These muscular
fibres, which may be traced from the ring to the testis, are sur-
rounded by a layer of the same tissue as that which composes the
central mass. We have the peritoneum, except at the posterior
part, investing all these structures. On laying open the inguinal
canal, the gubernaculum is, on careful dissection, seen to termi-
nate in three processes, each of which has a distinct attachment.
These attachments are as follows : the external and broadest por-
tion is connected to Poupart's ligament, in the inguinal canal ;
the middle forms a lengthened band, which escapes from the
external abdominal ring, and descends to the bottom of the scro-
tum, where it joins the dartos; the internal process passes
directly inwards, and is attached to the os pubis, and to the
sheath of the rectus muscle. These attachments, Mr Curling
Bays, he *^ has succeeded in tracing out, before the testicle has
descended, at different stages of the process, and inunediately
aflier its completion, when the fibres have assumed the situation
of the cremaster muscle," of the identity of which with the
cremaster, he says, no ** doubt can continue to be entertained.''
When we compare this description with John Hunter's, we
learn how nearJhBi fine observer came to the truth. When the
facts were not snffident, with what a power of generalizing
did he bring to his aid the facts observed by him in com*
parative anatomy I The microscope was little lued in his day,
and was not used at all by him ; he could not therefore prove
* These Tiewfl are alflo conUined in » pq»er bj Mr Cttrliog, fo the Blediol
Gaiette, April 1841, << Od the Stractme of <he OobcnuieiiltUDy md oo the Vtaemt
of the TutiM In the Fotni***
142 ON THS DISEASES OF THB TB8TS8
from dir^t obserTatioa the correctness of his belief of the
existence of the musculus testis, and that it subsequeniJj becomes
the cremaster muscle. He, howeyer, observed that in the in-
ferior niammalia the musculus testis did become the creiaiister,
ajid thence he c<»ichided from suiabgj wha4i Mr Curling has
proved by direct observation.
Here we cannot refrain from sayii^ a few w<»xb upon the
doubt which has lately been thrown upon the existenee of hkib-
cular £bres in the gubernaculum. This doubt arises from a
acepticdsm of the capability of the microscope to ^oahle us to
distinguish definitely muscular Sbre from other tissuea. TUn
scepticism is not at all warranted. We most readily grant, asmI it
would be beneficial if it were more generally allowed, that in tke
prosent state of our microscopic knowledge^ we are unable to
distinguish many tissues from others which hare very difierent
properties, but in this catalogue muscukyr tissue eaanot be phuad.
Thk organic el^aent has distinct and peculiur microscopic pro*-
perties, which prevent it from being mistaken for any othfir
animal tissue. It was mentioned above, that Mr Hunter ob-
awved the p^sist^ice of the gubemaculum in the scrotum in the
aduU. In this statement he is supported by Mr Curling, wIm
atates, '' that the middle attacbm^oit of the gubemaadum, which
may be traced to the dartos at the bottom of the scrotum, gradu^
ally wastes away, and soon becomes indistinct ; slight traees,
howeYex, of this attachment often renaiii imlil the latest period
o[ life. After death, in dragging the testide of an aduH out of
the serotum by pulling the cord, the lower part of the gland,
which is uncovered by serous membrane, is often found cooiifieted
to the bottom of the scrotum by a band of firm aad dense ceUniar
tissue, which requires division with a scalpi^ in order to eompleto
the s^M^ration. I b^eve this band to be tiie remains of the
middle attachment of the gubernaculum/'
We shall now finish our analysis and remarks on the first part
of Mr Curling's work by explaining his view of die process by
which the testicle is made to descend into the scrotum. This
process takes place in the same way in ihe human fisetus as in
some of the rodentia. Previous to the commencement of the
seaaon of sexual exdtemi^t, the testicles in these animak, as for
exanrple in the mole, are ^tuated in the abdomen. These glanda
are subject to remarkable periodical enlargement during the
season of copulation, when tiiey are drawn downwards by the
musculus testis to the external rings, where they are, by the ex^
AMD OF THE SPBRMATIO CORD AND SCROTUM. 143
pnlfflre actions of the diaphragm and abdominal mnsdes, pro-
truded without the abdomen, and are contained within the
cremasteric pouches which have been formed by means of the
iayersion of the gubernaculiun and musculus testis. In other
words, tiiie peritoneum, which formed the external surface of the
gubernaculum, now forms the internal surface of the cremasteric
sac, and in this way we haye the tunica vaginalis produced. As
the testicles diminish in size, which they do after the season of
sexual desire, their muscular coverings contract, and they are
carried up to their former situation in the abdomen, the peri-
toneum becoming again external, and each recently formed cre-
masteric musde again the musculus testis. A process exactly
aimikr to this takes place during the descent of the human
testicle. The musculus testis contracts and pulls the testicles
downwards, first to a level with the external and internal inser-
1i<His of the muscles ; they are then pulled gradually into the
scrotum by means of a process of contraction which is taking
place in the middle insertion. By means of this process the
portion of the gubernaculum testis which has descended below
its external and internal insertions becomes necessarily inverted,
L «. the peritoneum which covered the musculus testis now be-
coflaes iaiernal to that structure, whik that structure has taken
the relative position of the cremaster muscle. We have thus
fonned the tunica vaginalis and the cremaster muscle. This
eipknatioA (d the manner in which the cremaster nrasde is^ pro^
daced is at one with that held by John Hunter.
We have seen that John Hunter was unable to account for the
deaceni (tf the testicle. " It is difficult," aa Mr Gurhng well re-
marksy '' to understand why, after arriving at the former coDr-
viction, chiefly from analogy, he wad not induced by the same
process of reasoning to conclude, that a muscle capable of draw-
ing down the testicle in g^mmAlfl, would be adequate to acccnnplish
die same purpose in the foetus." He, however, did all but this.
We oonelude our remarks for the present on this subject in
the f<^ofwing words of Mr Curling : —
*'I see no i^ason to doubt that the cremaster diacliargetf tfce same office
in the human embiy o, as that which it undoubtedly perfonns in ontasa
anhDab ol a paiticular seoKm. The fibres pioceecGng from Poupart's Uga-
meat and the obliquus intenras tend to guide the gland into the inga jnal
canal, those attached to the os pubis to draw it below the abdominal ring,
and the process descending to the scrotum to direct it to its final destination.
As the deaceat approaches completion, the nraseulaor fibres which perform
so hnportant a part in it gradually become everted, assome new rektiona,
144
ON THB DISEASES OF THE TESTES
inyest the gland, and, instead of drawing down the testicle, acquire the new
functions of elevating, supporting, and compressing it."
Fig. 1.
Fig. 2.
Fig. 1.
A Peritoneam — B Nipple-shaped prolongation of do. — C Testicle lying behind
Peritoneum in Abdomen— D Middle insertion of Gubemaculam testis — ^£ Scrotum,
Fig. 2.
A Peritoneum — B Peritoneum prolonged into Scrotum, forming the tunica vagi-
nolis — C Testicle in Scrotum lying behind do.i*-D remains of middle insertion of
Oubemaculum — ^E Scrotum.
The descriptions given regarding the descent of the testicle
into the scrotum, by almost all those who have written on the
subject, are such in our opinion as to convey the idea that the
testicle, in its descent, acquires three serous coverings, — the one
which it had while within the abdomen, the other two on its de-
scent into the scrotum. " In this descent," says Mr Morton, for
example, '* they bring along with them the same partial covering
from- the peritoneum which they had when situated just below
the kidneys, which, with the production from the peritoneum,
already formed in the scrotum for their reception, constitutes the
tunica vaginalis testis."* We do not hesitate to state, and that
from our own personal observations, that no sac is prolonged into
the &croi\xmy previous to the descent of the testicle ; but that this
* Surgical Anatomy of Inguinal Hemis, the Testes and its Coverings, by Thomas
Morton, 1841, p. 280.
AND- OF THE SPERMATIC CORD AND SCROTUM. 146
organ coming down from the abdomen, brings a portion of the
peritoneum with it, and in this way the tunica vaginalis is pro-
duced. While the testicle is still within the abdomen, a small
nipple-like projection of the peritoneum, in the direction of the
canal, is all that as yet represents the tunica vaginalis, subse-
quently formed in the scrotum. The testicle, always mtimately
connected to the peritoneum, gradually descends, losing its attach-
ment to the part above, and acquiring a new attachment to the
part below, until it comes to the level of Ihe little projecting
pouch, behind which it passes, and carries it down with it to the
scrotum.
From the space occupied in this review by our remarks upon
Mr Curling's description of the descent of the testicle from the
abdomen into the scrotum, we shall be unable to enter at any
great length into a consideration of the second or principal part
of the work. We shall, we fear, be obliged to give but a very
general analysis of it.
The first chapter of this part of Mr Curling's work considers
and illustrates several interesting cases of congenital malfor-
mations and imperfections of the testicles. This chapter de-
serves no small praise. It is at once interesting, curious, and
highly practical.
Man's frame is a complex machine, being composed of several
organs, each of which has its own peculiar office to fulfil, and
they are all so dependent on each other, that the irregular action
of one soon perverts or destroys entirely the healthy actions of
the rest. Besides this, there is between some organs a much
closer connexion than between others. Such a connexion has
been proved by observation to exist between some part of the
nervous centre and the genital organs. Of the nature of this
connexion, however, we know nothing. Hippocrates says of the
Scythians, that when they were sick, they opened a vein behind
each ear ; when the blood had flowed from them, they felt them-
selves overcome by feebleness, and went to sleep. On waking,
some found themselves cored ; bat this was not the case with all
of them. " For my own part, I conrider that this method of core
was very hurtful to them ; because, behind the ears there are
veins, the section of which produces impotency." Baron Larrey
states, that he has found this remark of Hippocrates confirmed
by the Egyptians. We have also contained in the works of
many authors cases which seem distinctly to prove that a close
ooDnexicMi of some l^ind exista between the encephalon and the
146 OS THE DISBASBS OF THB TESTES^ &€.
flmctionft of the testes. We shall quote the following ca^ from
Mr Curling's work, in illustration of this point : —
^ A few jean ago, a man who had met with an injiuy of this description,
which had been fdllowed by wasting of the testea^ and tha deyelopment of
tumoun on each side of the chest, resembling mamme, presented himaelf
at the different ho^itals in London. I saw him in Biuch 1828, at the
London Hospital, when he had the appearance of a man who had seen hard
service. He stated that he was abont fifty-nine years of age, a married man,
and the &ther of seyeral children. He had belonged to the legion in the
Qaeen of Spam's service. About two years and a half previously, in an
attempt to Jump over a trench in a retreat, he fell backwards^ and injured
the posterior part of his head. WhUst on the ground he received a bayonet
wonnd on the left nde, and a sabre cut on the forehead of the sane ode^
He recovered &om these injuries, and returned to England. Binee the
accident he had completely lost his virility. He had no desire for sexual
connexion ; his penis had dwindled in size ; his right testis had gradually
wasted, and was no larger than a horse-bean, and the left gland was also a
good deal diminished in bulk. The skull, at the oociput, seamed somewhat
flattened."
Mr Curling has the following remarks upon this and other
oases of a similar kind which he has quoted i-^** We cannot doubt
that in these cases the loss of sexual desire, and the wasting of
the testes, were the direct results of the mjury of the lorain; and
they go far to prove the essential dependence of the functions of
these glands upon the cerebral organ."
The inflammatory and organic diseases of the testes which are
treated of here, are spoken of in the following order :— First, the
diseases of the protective parts or tunics, L e. the tunica yaginali&
and tnnioa albugenia; then the diseases of the glandular or
secreting structures ; and, lastly, those of the excretory parts.
We shall conclude our somewhat general remarks on tiiis por-
tion of the work under consideration, by the following excellent
and practical observations :~^
^ A carefbl examination into the merits of the various modes of efiecting
a mdical cure of hydrocele fully establishes the superiority of the treatment
by injection. The great error formerly committed by surgeons in endea-
vouring to excite a high degree of inflammation, arose from a mistaken
view of the object to be attained ; for not perceiving that the exndant
secretion could be correeted by altering the action of the vessels of the part,
they thought it necessary to obtain the obliteration <^ the natural pi^^ity,
which, moreover^ they endeavoured to effect by producing suppurative
inflammation of the membrane, instead of by the milder process of adhesion.
Injection has now been largely tried in this and other countries, and expe-
rience warrants in assertmg that, though it is not iafiillihle, of all tha
plans hiihsrto practised, it ^ombmes the greatest number of advantages^
The pain attending it is slight^ its effects are mUd, and at the same time
tolerably sure ; if properly performed, it is free from danger; and it fre-
quenUy succeeds without altering the natural eon^tfon of ihe ports.*^
ON THE STRUOTURB OF THB NRRVOUS SYSTEM* 147
Part IIL— PERISCOPE.
ANATOMlr AND PHYSIOLOGY.
On M0 Sirmeiure^ BehtioMf and FuneHant cf the Nerwue SyHem.
[Continued from our last.]
'^^imetiont qfthe Brain and Nenxnu Cord.— Although I lutye now pointe4
out the exutemce of fibres in the nervous cord of myriapoda and arachnida,
which lead us to the conclusion that the doctrine of the individuality w
i^ecial function of each fibre is coirect ; that there are fibres in every nerve
4erived from two distinct portions of the cord^ which, from their direct
coDUBunication with the brain, from one end of the body to the other, ave
believed to minister to volition and to sensation, and that other fibres also
exist in the same nerves, that have no communication whatever with that
oigan; and further, that some of these which are extended tnmsveraely
across the body, influence both sides of those individual segments to whi<^
they are distributed, and those only, while others combine in action two
or mote contiguous segments, but only by direct influence on one side of
the body ; — ^it yet remains to be shown by experiment, whether the assign-
ment of certain functions to tliese parts of the nervous ^stem^ in these in-
ferior animals^ is correct ;'— whether the results of experiments on theas
worm4&e beings agree in principle with the experiments already made by
many physiologists on the verteforated classes, and with those which thp
pathology of disease has afforded in man himself ;-^whether, as leading to
these important results, they coiucide with the first experiment made on
one of the oruatacea, conjointly by Dr Marshall Hall and myself, in thfi
spnng of 1834^ and with others subsequently performed by Valentin on the
same animal, and afterwards repeated by Dr Baly and myself in 1840 ; ancl,
lastly^ whether the seat of sensation and volition is confined entirely to the
supra-oesophageal ganglia, the brain in these articulata."
« Thee questions that require to be examined are—*
Utf Whether sensation and vdition are confined to the supraKCBSc^htgeal
gasglia, the brain» or whether they exist also in the first suboesophageal
ganglion, or in the other ganglia of the cord !
2d^ Whether these functions are destroyed by destruction of the bram !
8d^ Wheth^ there is any direct evidence of sensation in a portion of the ^
eord that is iusolated from the brain !
4dhy Whether the movements in these animals, when deprived of the
bram, are id^itical with those of the Crustacea and Tcrtebrata !"
^^EapeHment 1. — The front of the head, antenna, eyes, and brain, weve
at onoe r^noved with a pair of scissors from an active adult specimen.
Widle held between my fillers there were powerful contortions of the
whole body of the animal, and when placed on a table, it moved rapidly
forwards as in the usual mode of locomotion, and continued to do so for a
fewminiites ; but the motions gradually became slower and slower, and at
last were «o feeble that onwaxd progression was suspended, although tho
14S ON THE 8TEU0TURB OF THE NERVOUS SYSTEM.
legs were still feebly movedy as in walking, for nearly half an hour, when
their motions entirely ceased. There was no evidence whatever of sensa-
tion or volition, although the suboesophageal ganglion and cord were un-
injured. During locomotion the body moved in a direct line and always
forwards. When it met with a slight obstacle it climbed over it, or when
too high to pass over, the body stood directly opposite it with the mutilated
portion of the head in contact with the obstacle, and the locomotive actions
of the limbs gradually increased, apparently by the excitement of contact
with a foreign body against the lacerated surface of the head.''
*< When the movements of the limbs ceased, the body was maintained in
its natural position upon them for several hours, untU fresh mechanical ex-
citement was applied to it, when the locomotive actions were repeated."
" Experiment 2. — The head was removed from the body in the third
segment, the second of the trunk, and acts of locomotion were performed
by the body precisely as in the last instance, and were always re-excited in
the same manner. When turned on its back the body was instantly ex-
cited to violent contortions until it had regained its proper position, and
stood supported on the legs, which were extended, and slowly moved as in
locomotion, after it had continued to walk for four minutes. When the
anterior cut extremity of the cord was irritated with a needle, locomotion
forwards was again induced. Pressure on the anterior segment excited it
most readily. Motions of the legs were instantly excited by simple contact
with any foreign body, and those on both sides, anterior and posterior, were
moved, but insufficiently for locomotion. Violent contortions were always
induced when the body was placed on its back, until its proper position was
regained ; but the motions of the legs were not excited by a current of air
directed on them from a blow-pipe until after the lapse of a few seconds ;
but there was always a slight convulsive motion of the body after each sudden
current. The legs were less excited, during the first few hours after de-
capitation, by pressure on the posterior than on the anterior segments.- *
** Experiment 3. — ^The body was divided in the seventh segment while
the animal was running briskly. It continued to move forward for a few
minutes, but the motions gradually became slower and slower, as in the
preceding experiments. They were actively re-excited by a brisk sliake of
the table, but soon became quiet, with slow but very gradual motions of the
legs. Progression was always quickly reinduced by pressure on the anterior
segments, and this was more active tlian when applied to the posterior. It
was always reinduced when the cut extremity of the cord was irritated
slightly with the point of a needle. At the expiration of an hour from the
making of these experiments, the atmosphere continuing at about the same
temperature (56° Fahr.), the excised heads of Nos. 2 and 8 were still living,
and exhibited acts of volition, and that of the latter, with the segments and
legs attached to it, made attempts to walk. Both of these moved the antenne
briskly, and touched objects that were near to them, as if to feel and
appreciate."
" Experiment 4.— The body was divided at ihefimrteenth segment while
running. The anterior part exhibited all the voluntary actions of the perfect
' animal, those of touching, avoiding, or seeking an object, and also of locomo-
tion, but its movements were slow and were made with difficulty. This
arose from want of proper counterpoise of the body, since when that was
supplied by the proximity of the individual to the upright surface of any
object, locomotion was well performed. The remaining portion of the body
was then divided into two parts ; both of which were instantly excited to
ON THE STBUCTURB OF THE NEEVQUS SYSTEM. 149
moyements of the legs when irritated, but without any power of locomotion,
or ability of either part to support itself in its proper position. The motions
of the legs were readily induced by a current of air, or when the segments
were compressed, or the cut end of the cord touched with the point of a
needle. At the expiration of nine hours the anterior division of the body
with the head was dead, and not the slightest voluntary or reflex action
could be excited in it by any means. But the middle division of the same
individual was readily excited to reflex actions of the legs and contractions
of the segments, by compression of the segments, by irritation of the cord
with a needle, and by brisk currents of air from a blow-pipe. These re-
flected actions were much stronger in the third or posterior division of the
B^;ments, and were all induced by similar means. After twelve hours they
were feebler in the middle division of the segments, but were even more
leadlly excited in the posterior. After eighteen hours they were scarcely
perceptible in the middle division on the application of the needle, and not
at all on compression ; but they were still easily induced in the posterior,
and continued to be so in the four or five posterior pair of legs even at the
expiration of twenty-four hours. The temperature during the interval was
not higher than 64° Fahr."
{To he continued.)
Eopperiments by M. Chatin on the Mode by which Poisons are Absorbed.
If no one doubts that the absorption of the nutritive elements is effected
by means of the chyliferous vessels, two opinions are however held as to
how poisons are absorbed from without into the system. According to one
of these opinions, it is believed that the chyliferous vessels absorb indifier-
eaUXy all fluid substances contained in the digestive cavities. On the other
hand, the experiments of several physiologists, and especially those of
Magendie, support the other notion, viz. that the absorption of poisons is
efiected only through the venous system. M. Chatin has made a series of
experiments for the purpose of proving the correctness of one or other of
these opinions. After having poisoned a dog with arsenious acid, he obtained
arsenic from the blood taken from the heart and the large vessel, while the
chyle removed firom the thoracic duct did not furnish the slightest trace of
that poison. The same experiment repeated with tartar emetic led to the
same results. From these fEicts, with others of a similar kind, M. Chatin is
led to believe that poisonous substances are never absorbed by the chyli-
ferous vessels. — Stances de V Acadimie Royak des Sciences, Archives Gen^rales
de la Medecincy Avril 1844.
SURGERY.
On the General Laws of Displacement of Bones in Fracture.
In the Annales de la Ghirurgie there is a paper upon the above subject by
M. Edouard Lacroix, ex-Prosecteur de la Faculte, &c. The object
of the paper is to point out and illustrate a principle, which the author
believes to have a greater influence in producing the various displace-
ments in fractures than the weight of the limb, the obliquity of the
fracture, the action of the muscles, and the other causes which have
generally been regarded by surgeons as the active agents in producing these.
150 ON THE OBNERAL LAWS
He states thai he was led to pay attejfttion to the sabject by observiiig how
frequently the dispLioemeiftts met with in praotioe were at vananoe with
those which authora^ led by the known action of the muflcle% had been in
the habit of describing them to be,
" Smgeons^*' he 8ay% ^^ have very properly taken into consideration the
obliquity of the fracture and the weight of the limb ; but after these, they
have been in the habit <tf considering the muscles as acting wiUiout any thing
to counterbalance or modify the direction which they give to the fragments"
The fact, he remark^ which struck him in the oouise of his observatkms^
was the great resemblance existing between the bones in which deformity
had been produced by badly set fractu^ and those in which it had been
the consequence of lickets, — a resemblance so gfeat in some instances that
it was difficult at fiM to say to which of the two it was to be letored. *' I
was thus naturally led," he continues, *^ to draw a comparison between those
)M>nes which had undeigone some change in their powers of resistanoe &om
ihese canses. It was eyident that the only difference estisted in the gtisater
or less fiwiUfy with which the bones yidded to the action of the muscles.
Jb rickets^ the Curve is gentle and equal, because the bone yields but dowly,
and in all parts equally ; whereas in fracture, it is abrupt and llmitsd to the
part where the bone is deprived of its power of resistance.
The fractured bone, however, he says, must be subject to the same laws
of muscular contraction, because its extremities are not entirely free, —
fibrous and muscular bands necessarily limiting the displacement of the
fragments. This condition of parts^ he concludes^ constitutes a very great
difierence between fractures and dissected prepamtiidlis^ ki which, after isola-
ting the knnscles and depriving the bone of its coverings^ surgeons faavte
be^ in the habit of studying the action of the muscles upon th^ diWded bone.
M. Lactoix believes that the natural curvatures of bones are dependefe^t upon
mufloular contractioik, and tiiat these curves are identical with thote WUch
we meet with in rickets and &acture%*^the latter only differing firom ike
forme/ in their being more marked.
He then concludes generally, ^Uhat displacement of the fractured bones
takes place according to angles which correc^nd in plane tod diredbion with
the natural curvatures of bones." Hesupports his doctrine hy tefereDee
to the prepinations in the museum of Diq^uytrea, r^rting to ikexbL by
numb^. We have not space to follow him throughout, but shall give one
or two of his illustrations in different fractures. Before doing so, ^we vet ,
we may remark, thafc we cannot consider the principle which M. Lacroiic
lays down to be bo geneital in its applidEition as he would lead us to believe.;
although we are willing to grant that it exerts an influence, and perhaps a
very powerful one, in determining the nature of the displacement. We
cannot help thinking that M. Lacroix has been too anxious to lay down as
a general law what ought only to have been regarded as one amongst the
many causes which lead to the various displacements in fracture. He has,
if we may judge from his statements, been very naturally led to do so from
the examination of the preparations to which he has had access ; but had
he <extended his inquiries, we have no doubt that he would have been led
to tfttaoh to his observation its true value. We shall advert to M. L.*s
observaticms on two fractures only, as confirmative of what we have said.
The filfet we shall refer to is that of the clavicle, and the second that of the
shaft of the femur. M. Lacaroix, we may remark, takes the descriptions
t>f Biohat and Boyei^ ab representing the opinions of the generality of sur-
geoiii.
OF DISPLACEMENT OF BONES IN FRACTURE. 151
In the w&rka of both of these aathoTS we find the displacement of the
extevnal portion of the clayicle in fracture described as being downwards^
inwards, iufdfifrwird». ^ If," says M. L., ^ we take the deseriptiona of tkcfe
anthoTB as the most detailed and exact, we find that they can only hare
described those fractures situated at the inner third of the cavide* J£ we
pay attention to the law which I have laid down, we find that wl^^n thei
fiactare is situated at the union of the two external with the internal third,
the displacement of tiie external fragment is forwards ; whereas, if it be
BMted at the union of tho two internal with the external third, the aommial
portion is carried backwards, and that whatever be the direeticMi of tha
obliquity of the frseture.** In t^is ft»<ture the real state of mattcirs ap«
peasi to bear out what is said by M. Laoroix. We have examined a good
many prepaiwtions of fVaeture^ daviole, and we have found, we may almost
say without exception, that the fact is as stated by him. The fineture in
the outer curve, we mav i>emark, is by ftff the most Qomm<»i ( in fi|o4, it
is rare to meet with ftaoture at ^e laner ^ird. Th^ finotures of ^e shaft
of the femur do not, we believe^ contend sq eloeely with the des^iptiona
given by ouf author ; in Ud^ the exeeptions are so frequent as to deprive
his ttKplanation of aXL claim^ to* the tHle of a eeneial law, ** The examina*
tion ef the numerous preparations,** says M. Laovoix, *^ m the museum of
Dupuytren, shows that wbatevep be the seat of the f^oture — whether it be
simple or comminuted — the upper fragment is placed in front, and forms
ia this direction a projection more or less eonsi^evable, more Mr less acute,
and pomted outwards^ The extremities of both superior and inferior por-
tions are directed outwards, and the axes of th0 fragments form an angle,
the concavity of which looks inwards.'' M. Laoroix appears to have ex-
amined the preparations in the museum of Dupuytren only, and we have
no doubt that in so fiir as they went he was amply home out by them ; but
this just shews the danger of forming general kws on limited observations*
In our own hiquiries into this subject, we have by no means come to the
same conclusion ; in fiict, we find the eases which deviate from his general
law ^most as numerous in some respects as those which concur with it.
In thirteen preparations, for example, taken from a private museum, we
ind the followhig to be the actual state of the fiust :— In nine^ the superior
fragment was anterior, as described by M. Lacroix, and in four posterior.
In^w, the curve was outwardly as described by him ; in «m?, imoardfy show-.
ing a result very difierent from what we should have been l^d to expeet by
him. We have also run hastily over the preparations in some otheor
museums, and in them likewise we find the exceptions very numerous.
The oUiquity of the fracture, and its seat, as well as th<$ mode in which
it has been produced, appear to exert a much more powerful influence
than the law laid down by our author. This was clearly shown in many
of the preparations to which we have referred above. It was evident, for
instance, that it was to the direction of the obliquity of the fracture that
in so many cases the inferior fragment was anterior to the upper one,
instead o£ hemg posterior to it, as described by M. Lacroix ; the obliquity in
these cases passing from behind upwards and forwards in the lower fragment,
and the reverse of course in the upper. In like numner, the ipfluenoe of
the seat of the fracture was well shown in these ; the fracture in almost
all those in which inversion or the curve inwards existed— constituting, aa
we have sdd, the majority— -being through the lower part of the shaft, the
adductors being thus allowed to act almost without antagonist.
We do not tbmk it necessary to follow M. Laeroix further in his observar-
152 ANEURISM OF THE ILIAC ARTERY.
tions. We have pointed out sufficient grounds^ we conceive, to show that
the explanation which he gives is by no means entitled to the appellation of
a general law, but can only be regarded as one amongst many causes which,
imder certain circumstances, determine the character of the displacement
in fracture.
Case of Ligature of the Common Iliac Artery for Aneurism of the External
Iliac, By Richard Hey, Esq., Surgeon to the County Hospital, York.
We insert the following case because we believe it to be the first instance
in which the common iliac artery has been tied successfully, in this
country, for aneurism. This artery has been tied repeatedly by different
surgeons, but only once successfully for aneurism, so &r as we can recollect, by
Dr Mott. It was first tied by Professor Gibson, in a case of gunshot wound,
but the patient died on the fifteenth day. It has likewise been tied by Mr
Crampton of Dublin, and Mr Syme, but in both the issue was unfortunate.
In the latter case any other issue could scarcely have been hoped for, as
mortification had commenced previously, requiring subsequently the ampu-
tation of the limb. The ligature of the artery had been performed as af-
fording a chance, although a desperate one, of saving the life of the patient.
In 1833, Mr Guthrie tied this vessel for a tumour supposed by him to be
aneurismal, but which proved to be of a medullary chiuacter.
^ Mr Taylor, aged forty-one, residing at Acomb, near York, seen in consulta-
tion with Mr Nelson, surgeon, and Mr EUis, on the 22d November 1843. I
received the following history of his case : —
^ On the 10th of this month Mr Taylor perceived a stifiness and uneasiness
in the left groin, and on examination found a small hard tumour imme-
diately above Poupart's ligament, midway between the anterior superior
spinous process of the ilium and the tuber of the pubis. Having been
occasionidly subject to scrofulous tumours, ending in suppuration, he sup-
posed this to be an enlarged gland, and therefore at first took but little
notice of it ; he showed it, however, to his medical attendant, who pre-
scribed suitable remedies for its removal. On the 13th he was suddenly
attacked with severe pain in the tumour, and on the following morning it was
found to be much increased in size ; and now, for the first time, a decided
pulsation was observed in it ; pulse 90. From this time until Uie 22d the
tumour made perceptible advances in size daily, accompanied with pain
along the course of the anterior crural nerve.
^' November 22. The tumour is now the size of a pretty laige orange ;
the impulse very strong. It was, however, easily emptied by moderate
and continued pressure, instantly filling again when the pressure was re-
moved. Pressure on the aorta had the same effect, but in a lesser degree.
When the base was grasped, the fingers at every pulsation were forcibly
separated, and equally so on every side. There was clearly aneurism of the
external iliac artery.
^ November 28. The tumour rapidly increasing in size ; and as there
seemed to be no alternative but placing a ligature upon the common iliac
artery, or speedy death, I thought it my duty no longer to delay acquaint-
ing him fully with the state of the case : he was not prepared, however,
at present, to decide upon the subject.
" November 30. The tumour now, from having a round and uniform
surface, had become conical^ like the pointing of a large abscess, the skin
also much thinner, red, and shining. We therefore uiged upon our
ANEURISM OF THE ILIAC ARTERY. 153
patient the necessity of a speedy determination ; and at his request, my
brother^ Mr William Hey, of Leeds, was requested to meet us in consulta-
tion.
<< December 2. We met this day, and found the tumour within the last
forty-eight hours had so much increased as to render any further delay of the
operation extremely hazardous ; and as Mr William Hey concurred with
us in the propriety of attempting to save our patient's life by the means
already proposed, and as he was now quite willing to submit to it, we
determined to wait no longer than the following morning.
'^ Sunday, December 3. I proceeded to place a ligature on the common
iliac artery. It seemed out of the question to attempt tying the external
iliac, because, from the very large size and extent of the sac, it was evident
that there would not be room for a ligature between that and the bifurca-
tion of the external and internal iliacs ; and in addition to this, the pro-
bable state of that artery made it unwise to run such a risk, even if it had
been practicable.
^ There were present at the operation Messrs Nelson and Ellis, Mr
William Hey, and Mr Teale, of Leeds ; Mr Dodsworth and Mr Reed, of
York ; to whose kind and very able assistance I feel deeply indebted.
*^ The tumour now occupied the whole of the left iliac fossa, its base
projecting considerably below Poupart's ligament inferiorly, and superiorly
extending to within less than an inch and a half from the navel, being six
inches across from above to below, and six inches and a half from side to
dde ; projecting also from the plane of the abdomen fully three inches.
** The patient was placed on his back on a mattress, his shoulders mode-
rately raised. The incision was commenced two inches and three-quarters
above the navel, and exactly three inches to the left of the median line.
This was carried down moderately curved to the base of the tumour
about six inches, and was afterwards enlarged by an angular continuation
one inch and a half in length. The fibres of the external and internal
oblique muscles and transversalis being successively divided, the transver-
salis fascia was readily raised by means of a director, and carefully opened
out through the whole length of the incision. The 'peritoneum now
protruded in some measure ; it was, however, kept down without much
difficulty ; and being gently drawn towards the opposite side, I was
enabled slowly to insinuate my fingers behind the peritoneum, gradually
separating it from its cellular attachment to the parts beneath. The
common iliac artery was easily reached, and upon compressing it with the
fingers, the pulsation in the tumour ceased at once. A little time was
occupied in scratching through the sheath of the artery with the point of
the aneurism needle ; this being accomplished, the needle was passed
under the artery from within outwards, armed with a double ligature of
staymaker's silk, waxed. By holding aside the peritoneum and viscera,
we now obtained for a moment a view of the artery, and ascertained that
nothing else was included in the ligature ; this being tied with the fingera
close down upon the artery, all pulsation in the sac entirely ceased, and
never afterwcu*ds returned in the slightest degree. The exact position of
the ligature was, I believe, an inch below the bifiircation of the common
iliacs. The wound was closed with six sutures and strips of adhesive
plaster ; and over the whole a coating of lint dipped in strong mucilage.
Time, 26 minutes. The patient was now a good deal exhausted, although
80 little blood had been lost that it had not been necessary to take up a
single bleeding vessel ; he vomited also some brandy and water which had
V
154 MATERIA MEDICA AND BIETETICS.
been giren to him during the operation. He took, however, a cup of
boiled milky which was retained.
*^ Evening. Patient had been very restless and uneasy after the operati(m
for some houn. A camphor draught, with 26 drops of Battley's sedative,
had had the effect of composing him. There was now moderate reaction,
pulse 90. The wound continued stUl very uneasy/'
By the 4th January the patient was quite well.-^Pr(w#iido/ MeHcai and
Surffieai Journal, No. 5, May 1, 1844.
MATEMA MEDICA AND DIETETICS.
InoeukUien wiih Tartar Emetie io produee a Cmmter^IrrUant ErupHem on the
Skin,
Dr Debourob, in the ^ Gazette des Hopitaux" for Januaxy 1844, pro-
poses to avoid some of the inconveniences of the tartar emetic ointnient
by inoculating the skin with tartar emetie. He puts a pinch of tartar
emetic on a piece of glass, and moktens it with water ; then taking a little
of the moist mass on the point of a lancet, he makes as many punctures in
the skin as he thinks necessary. These punctures very soon inflame, and
the resulting pustules may be enlarged at pleasure, by applying a solution
of tartar emetic by means of a hair-pencil. This i^an seems worth a trial,
which we have not yet made, because we continue to find the croton-oil
liniment answer so admirably for the purposes of counter-irritation.*
Effect qfErffot ofBge in Palsy of tJie Lower EMremities,
Db Ducbos of Marseilles {Journal de CRnique de Marseille) reports a case of
palsy of the lower extremities of long standing, in which the eigot of rye was
productive of much benefit. The patient, at eighteen years of age, had a
severe fall on his back, which was succeeded by weakness of the lower ex-
tremities. His Umbs soon recovered their natural strength, and he re-
mained weU for a year. The history of the case during the next twenty-five
years is summarily disposed of in these few words : ** An bout de ce temps,
rechute." The patient was forty-four years of age when he came under Dr
Ducros* care, and he was then affected with complete palsy of the lower
extremities along with incontinence of urine.
At first about 4 grains (25 centigrammes) of the powdered ergot were
administered in pills ; this quantity, we presimie, was taken at least daily,
though that is not stated. The dose was progressively increased, so that
after rather more than six weeks, he had come to take upwards of 20
grains at once (1.50 gramme).
At this time the patient presented a remarkable improvement. He
could now stand firm on his legs, and walk ; he could also control the dis-
chaige of urine. Soon after it became necessary to dim iniab the dose of
the ergot, on account of the tingling produced by it in the soles of his feet.
The use of eigot in diseases of the nervous system has been hitherto
little attended to, or rather almost entirely neglected. One case, such as
that just referred to, wiU not go for much, especially of a disease like
paraplegia, which has sometimes disappeared suddenly without any treat-
ment — ^most probably because the disease has slowly ceased hj the efforts of
* Scottish ttnd NmDi of Eng^md Med. Cassette, No. V.
PATHOLOGY AND PRACTICE OF MEDICINE. 155
nature, often a consideiahle time before the patient himself discovers that
he is cured. But in confirmation of the probable good effects of ei^t in
the above case^ we should notice the sufficiently well known influence of
f%ot on the nervous system, analogous to the effect of narcotics, marked
^K giddiness, delirium, and dilatation of the pupil, while we learn horn
^^le's learned memoir on ergot, that there are oflier cases of paraplegia in
'^hich it has been found beneficial.*
PATHOLOGY AND PRACTICE OF MEDICINE.
Conneaian between Hydrocephalus and Disease of Lungs. M. Mavtbner.
In 229 dissections, made between the years 1837 and 1842, of children
who had died of encephalitis and acute hydrocephalus at the Foundling
Hoflpital of Vienna, M. Mauthner found the following appearances : — In
172 casea^ serum in ventricles with or without material alteration ; in 123
casefl^ where the effusion was copious, tubercles occurred in the lungs 43
times (20 of these with hepatisation) ; hepatisation without tubercles^
90 times ; and complete solidification of a part of the lungs in 7 cases :
hjdrothorax, 14 times; hydropericardium^ 61 times; ascites, 10 times;
cedema of the lungs, 39 times : so that in 133 cases where there was ef-
fosion of serum in the ventricles, there were fbnnd in 86 mortal diseases
of the lungs, besides many affections of the abdominal viscera, among
which tubercles of the spleen occurred 42 times.
Inflammation qf Columna CamecB a Cause of Insufficiency of Valves,
M. Hamerujk of Prague has published some interesting observations on
inflammation of the muscular substance of the heart, which he believes to
be £!^uent, and to occur usually in the left ventricle. The anatomical
charactovs are hyperemia, infiltration with exudation into the cellular
tisRie and atrophy of the muscular fibre, suppuration, abscess. The mus-
cular tissue becomes flabby, and when examined with the microscope is
found to have lost its spiial appearance, become less smooth, and covered
with little pulverulent bodies.
IL H. thinks it difficult in some cases to distinguish inflammation from
&tty degeneration of the heart, and relies chiefly on the microscope and
the application <^ heat for establishing the diagnosis. The object of the
paper, and it is an important one, is to show that without any disease of
the valves themselves, they may be rendered insufficient by inflammatory
disease of the columns cameee having destroyed the tonicity of these
minolee, and rendered them incapable of duly performing their function of
closing the valve.
Vaccination latent for Three Tears.
M, Wenwoer of Vienna has published a case where vaccination was
performed on a child eight months old in July 1887, and did not become de-
veloped till July 1840, thus remaining latent for three years ! 1 1
• See Bayle,— Bibliotheque Th^rapeutique, tome iii. p. 648.
156 PATHOLOGY AND PRACTICE OF MEDICINE.
Tartar Emetic as a Remedy fir Syphilis,
M. WiLLEBRAND lias been employing tartar emetic for the treatment of
syphilis in the Military Hospital at Helsingfors, the capital of Finland.
Employed in primary syphilis, the sores healed in from 12 to 20 days. It was
not, however, tried in indurated chancre. Its effects were most strikingly
beneficial in secondary affections of the throat and scrotum. In thirty cases
the symptoms disappeared in 11, 12, or 15 days. The tartar emetic was
usually continued six or eight days after the disappearance of the symptoms.
When given in the skin affections, S. roseola disappeared in a few dis-
eases. The squamous class were more unmanageable, lasting from 20 to
26 days. The inconveniences attending the prolonged use of the remedy
often required it to be given up before the completion of the cure.
The tartar emetic was exhibited in doses of half a grain six or eight
times a-day. The first doses commonly produced vomiting, but tolerance
was usually established on the second day. To this, however, there were
exceptions : one case is recorded where the dose could not be raised above
the eighth of a grain without acting at once on the stomach and bowels.
[We have observed the most remarkable difference in this respect in ex-
hibiting tartar emetic pretty extensively for chest affections. We usually
give it in doses of half a grain every hour, in some cases the first or first
and second dose provoke vomiting, in other cases it does not occur till the
third has been swallowed ; sometimes the patient does not vomit at all,
while in others, again, the remedy provokes vomiting at every dose. In one
case of a child of two years ol^, §ii. of antimonial wine were taken in doses
of a tea-spoonful every hour without emesis, while two tea-spoonfuls of the
same preparation, when swallowed by ourselves, produced severe nausea
and vomiting]. The general health was also carefully attended to by M. W.
loduret of Potassium in Saturnine Affections,
At a late meeting of the Academy of Sciences, MM. Natalis Guillot and
Melsens called the attention of that body to the favourable results of the
ioduret of potassium administered in the treatment of saturnine diseases.
Hitherto they have administered this substance alone, allowing the patients
to live as usual, when their state admits of it, as regards food. They gra-
dually increase the dose to 5iss or 3ij a-day. From six to ten ounces of
the ioduret has appeared to them sufficient to complete the treatment.
Their object in giving publicity to these facts is, they say, to give rise to
further experiments on the therapeutic action of the ioduret of potassium in
these affections.
MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN.
Pelvic Inflammation after Parturition,
In Guy's Hospital Reports for April of this year, there is a conmiunication
on a subject which is very important to those who take an interest in
obstetric medicine and surgery. It is by Dr Lever, of whose labours we
have had occasion to report so favourably in our last number. Dr Lever
furnishes the results of his experience in nine cases of pelvic abscess occur-
ring at various periods after parturition ; in one instance, so late as eight
weeks after this event. Dr Lever considers the inflammation of a chronic
character, an opinion by no means happily chosen, and which, were it not
PELVIC INFLAMMATION AFTER PARTURITION. 157
that we might be considered hypercritical, we could easily refute. These
cases, though they must have been occasionally met with, have been little
noticed in our literature since the time of Levret, probably because they
ahnost always terminate favourably. The young practitioner, however,
whose mind is often haunted with the consequences of inflammation in the
puerperal state, ought to feel under considerable obligations to Dr Lever for
his excellent practical communication. In six of the cases the abscess
burst per vaginam, in three at either groin ; in one of this number the
contents were discharged both at the groin and by the rectum ; in one
there was suppuration at both groins ; in one of the cases the abscess fol-
lowed an attack of puerperal fever ; and in another of them, phlegmasia
dolens succeeded to the abscess. In our own practice, we remember one
case which supervened on uterine hemorrhage, two on puerperal fever, two
after the use of forceps, one after an easy first labour; and in the last
instance which occurred to us, an abscess formed at each groin after a first
labour, which had been easy, and in which there had been no artificial
interference ; in one of these only did the abscess burst per vaginam, in
none per rectum ; and all of them happened within a fortnight after
delivery. Dr Lever does not ofier any decided opinion as to the cause,
which shows his good sense, since such cases have been observed after easy
as well as difficult labours — after deliveries |Where there was no inter-
ference, as well as subsequent to those in which artificial aid had been
afforded. As, fortunately, post mortem inspections are rare, it would be
hazardous to state, in decided terms, in what structure the inflanmiatory
action commences ; but we are certainly disposed to concur in Dr Lever's
views on this head, by believing that the cellular structure of. the pelvis is
involved, as also one or more of the uterine appendages — an opinion sup-
ported by the contents of these abscesses being, in the majority of the cases,
evacuated external to the peritoneum.
The most important point for consideration in these cases is the diagnosis.
We know from experience how readily they may be confounded with other
and more severe inflammatory affections in the puerperal state. Rigors,
accelerated pulse, heat of skin, and pelvic uneasiness, are among the pro-
minent features of these cases ; but it is to be particularly remarked, that
they are not attended by that anguish and general tenderness of the abdo-
men, so characteristic of those affections usually denominated puerperal
fever ; — ^that the uneasiness, though accompanied by a good deal of general
disturbance, is more local, while the patient is completely alive to every
thing around her. Sometimes the uterus feels larger than it ought to be
at a period so distant after parturition as that at which the disease com-
mences ; but in other instances nothing unusual can be discovered by the
most careful examination over the pelvic brim. Per vaginam, again, our
investigations are not, in some cases, more satisfactory. Often, however,
this canal feels very sensitive, hot, contracted, and very painful ; and the
patient shrinks during its exploration, complains of great uneasiness at some
particular point, where, probably, we discover some swelling. Though we
are not disposed to dispute the value of Dr Simpson's sound in cases of
uterine disease, unaccompanied by tenderness of that organ, yet we cannot
concur with Dr Lever in thinking that any sound, except sound sense, can
be safe when the uterus is in a state of high irritation. We reprobate the
practice of poking instruments into the uterus when highly excited.
Although we have admitted that these cases eventually terminate in a
fevourable way, nevertheless we consider an early distinction of them from
168 INHALATION OF OXYGEN.
other more fonxudable affections of the last importance, if it were for no
other reason than to prevent unnecessary depletion by the lancet, which
would be certain almost of rendering the system most irritable, and incapa*
citating a woman for the important duty of nursing. Dr Lever^s manage-
ment of these cases is very judicious : leeches to tiie pained parts, warm
fomentations, tepid ablutions of the sexual canal, enemata, and antiphlogistic
regimen in the acute stage, but a generous diet afterwards, are &e reme*
dial steps.
FORENSIC MEDICINE AND MEDICAL POLICE.
Inhalatum ofOofygen an Antidote to Poisoning with Carbonic Add.
^ An apothecary was engaged in a confined cellar in the preparation of nitric
ether from a mixture of alcohol and nitrate of potass : during the process
a lai^ quantity of carbonic acid and carbonic oxide were given off: his
assistant, who was suddenly seized with a painful sensation in the head, and
covered with perspiration, was sent out ; he himself however remained in
the cellar 15 or 20 minutes longer, and, just as he was in the act of leaving
it, he fell senseless on the steps. He was immediately brought into a chamber,
where he lay motionless, with the eyes closed and the face of a pale yellow,
with the exception of the cheeks, which, together with the lips, tongue, and
hands, were livid ; the pupils were fixed and somewhat dilated ; all the senses
had entirely disappeared ; the carotids beat violently, the action of the heart
was frequent but weak, the pulse scarcely perceptible, and the breathing
weak and irregular. The cold douche was used without benefit. In order
to free the lungs and brain from engorgement, blood was drawn from the
arm ; it was of a chocolate-brown colour, of the consistence of syrup, and very
quickly coagulated. After this the breathing appeared somewhat more firec^
perspiration covered the body ; but the sensibility of the skin seemed in no
degree increased, for a sinapism which was applied to the breast showed no
effect upon it. As none of the means employed seemed to be of much use^
a quantity of oxygen was prepared, in order by inhalation to oxidise the
blood, overloaded with carbon, more rapidly than could be done by the
inhalation of atmospheric air merely. After the patient had been in a
state of insensibility for an hour and a half, he was made to inhale the
oxygen for a few minutes. A remarkable reaction followed : the ale of the
nose dilated, the appearance of the counten^mce improved, the muscles of
the jaw and mouth began to act when loudly addressed ; there was motion
of the eyeballs, the breathing became normal, the pulse fuller, the skin
perspired freely, and the patient seemed to feel the ntustard cataplasm.
After he had used, in the space of a quarter of an hour, two and a half quarts
of oxygen, when loudly spoken to he awaked as if from sleep, and att^oopted
to rise, but his sight had not then as yet returned. After the above state
had lasted two hours and a half, and after he had slept fi>r half an hour, the
senses were completely restored, and some blood which accidentally fbwed
from the arm was again become scarlet. Some of the blood which was
analyzed yielded 50*8 per cent, of carbon and 7*1 of watery fluid.'* — Cas^x
Wochemchryt, No. 47, 1843.— It appears to us that cupping should have
been employed, as that mode of abstracting blood has been found the most
beneficial in such cases. We may perhaps assume the dark colour of the blood
as a proof that the diluted carbonic acid enters the lungs, — ^thatin £M;t it acts
IBS a poison, and not merely as an asphyxiating agent^ by closing the glottis.
COMPARATIVE WEIGHT AND LENGTH OF FCETUS. 159
Comparative Weight and Length o/FeUtu bom at the full Time.
As there are numerous questions which arise on triab for infanticide, &c.y
where the weight and length of the foetus at hirth is of importance to he
known, w€ are induced to extract the following recent observations of M.
Elsaesser of Wurtemheig :—
In 1600 children he found
13 weighed from 4 to 5 pounds. 318 weighed from 7 to 8 pounds.
168 d ... 6 ... SS 8 ... 9 ...
417 6 ... 7 ... 11 9 ... 10 ...
The average weight to be deduced from this is 4 lbs. 28 loth (or half
oances). The lightest child weighed 4 lbs. 23 loth, and the heaviest, 9 lbs.
30 loth. M. £.'s results differ somew ha t from those of other authors ; for
example, Mde. Lachappelle met with one child at the full time weighing
3^ lbs. Qiamaaier, in 1601, found 3 we^hii^ 2 lbs., 31 of 3 lbs., and 97 of
4 lbs., tiad he also observed others weighing II, 16, and 17| lbs. We
think, however, with M. E., that these statements of Chaussier ought to be
received with a due degree tf cautian ; sadh cases certainly present very
lue exceptions to the general rule. M. £. found that
llie aven^ weigM of 100 males was 7 lbs. Of loth.
«.. ...
,,
females
6
... 21
...
Tbe maximum weight
of the males
9
... 30*
...
... ... •
,,
females
lot
... ...
...
The minimum we^ht
of the males
4
... 28
...
... ...
..
females
4
... 19
...
Of 260 children
The length in 11
was from 15 to 16 inches.
... ...
99
...
16 ..
. 17
...
... ...
75
...
17 ..
. 18
...
... ...
14
...
18 ..
. 19
...
... ...
1
...
19 ..
. 20
••.
Hie average length
of 100 males
was
17 inches 3^
lines.
... ..
females
...
16
... 8
...
The maximum length of the males among 1000 children
was 19 inches 17 lines.
The maximum among the females 19 ... 1 ...
The mmimum among the males ... 14 ... 15 ...
The minimum among the females ... 14 ... 9 ...
There is therefore a difference in length, as well as in weighty in fkvonr
of the male children. We are glad to observe that M. E. has also directed
lus attention to the comparative lengths of the supra and infira umbilical
portions of the body. His observations will be of use in doing away with
the absurd notion, so confidently put forth in most works on midwifery
sod medical junsprudenee, that in the ehM bom at the fUQ time tin
imibilicus is the centra! point of the body.
In 200 children the length of the suprarumbilical portion of the body was
In the males 9 inches 2| Ihies.
females 9
The length of the infra-umbilical portion was
In the males 7 inches 9 lines
... females 7 ... 7 ...
* In leveral cases. f In one am only.
160 EDINBURGH MATERNITY HOSPITAL.
The difference of lengtli between the two portions was
In the males 1 inch 3-40 lines,
females 1 ... 3*57 ...
In one case the infra-nmbilical portion was 3 lines longer than the snpra-
nmhilical ; in another (one only) they were exactly equal. M. £. has also
ascertained, that the distance from the ensiform process of the sternum to
the umbilicus is generally about one inch longer than from the umbilicus
to the symphysis pubis. The author also concludes from his observations,
that variations in length are much leas than those in weight, the former
being : : 16 : 20, but the latter : : 6 : 10.— ITcn/reV Zeitschrift fur die
Staate Arzneikiindey No. 42, tom. iv.*
Part IV.— MEDICAL MEMORANDA.
EDINBURGH MATERNITY HOSPITAL.
J^'oR some time past the attention of many of our influential citizens and
medical brethren has been directed toward the establishment of a Maternity
or Lying-in Hospital. Since the hospital of the late Professor Hamilton
has ceased to exist, the want of clinical obstetrical instruction on the great
scale of a Lying-in Hospital is a stain on the medical school of Edinburgh,
in other respects one of the £rst in Europe ; but when, apart from any ad-
vantage to our medical school, we consider the object in view solely in a
philanthropic light, or when we regard the mere motives of humanity which
liave prompted the attempt to establish such an institution, we are grati-
fied to know, that after many consultations and much tedious deliberation,
matters are so far in train that we may hope to have this desirable and much
wanted institution in early operation. It is already under noble and dis-
tinguished patronage, and we are assured that the highest in authority in
these realms will be happy to confer on an institution intended to relieve
the sufferings of her sex the benefit to be derived from her patronage. It
will not, like the last, be the hospital of an individual, but it will be the
hospital of the public — ^to apply for aid will be all the recommendation re-
quired. A medical staff has already been appointed ; and the selection that
has been made does the highest credit to the judgment of the directors, and
gives us the fullest guarantee of their capability and willingness to direct the
afiairs of the institution In such a manner as will be most conducive to its
utility. The following gentlemen have been appointed :
Consulting Physicians — ^Dr William Campbell, Dr Beilby.
Ordinary Physicians — Professor Simpson, Dr Moir.
Assistant Medical Officers-^DT Charles Bell, John Niven, Esq., Alexander
Thomson, Esq., W. S. Carmichael, Esq.
Consulting Surgeon^Dv Pagan. Ordinary Surgeonr—Alex. Zeigler, Esq.
• The Wurtemberg pound is equal to 1.0314 English avoirdupois, and the inch
is equal to nearly *94 of an English inch.
Printed by OUver & Uoyd, TwMddale Court, High Street, Edinburgh.
THE
NORTHERN
JOURNAL OF MEDICINE.
No. III.— JULY 1844.
Part I.--ORIGINAL ARTICLES.
Cases of rare Malignanb Disease of the Ovary. By J. C. W.
Lever, M. D., Member of the Royal College of Physicians,
London ; Assistant Accoucheur at Guy's Hospital, and one of
the Lecturers on Midwifery at that Institution ; Author of a
Practical Treatise on Organic Diseases of the Uterus.
Cask 1. — Mrs F , set. forty-six, the mother of six
children, the youngest six years of age, consulted me in April
1843. She stated that, two years previously, she suffered from
pain in the region of the liver, for which she placed herself
under the care of a distinguished physician, who ordered
blisters and various modes of relief, and at last advised her to
leave London. This she did, and the pain subsided.
Eighteen months afterwards she perceived, immediately
above the left groin, a hard moveable swelling of a circular
form, unattended with pain, and even firm pressure caused but
little suffering. Its size increased, and it was associated with
menstrual irregularity, loss of appetite, languor, despondency,
&c. She again sought the advice of the same physician, who,
after a very careful examination, pronounced the uterus free from
disease, but stated that in his opinion the ovary was the seat of
mischief. The treatment prescribed was simple and palliative,
but the tumour rapidly enlarged.
In April 1843 I first saw her. Her countenance was pale
and anxious, her alse were compressed, her cheeks hollow and
drawn in, the superficial veins of the body generally were
very distinct, and she was much emaciated. There was some
swelling of the left thigh, leg, and foot, which indented when
pressed by the finger. The abdomen was of irregular form,
from a tumour wmch occupied the left side, apparently rising
out of the pelvis. This tumour had a firm but elastic feel ; it
could be traced into the left loin as high as and under the
Tibs, and in front it could be detected as high as the stomach,
X
162 RARE MALIGNANT DISEASE OF THE OVARY.
although its superior margin could not be accurately defined ;
it extended to the right of the mesian line, and on its surface
there were three other tumours the size of walnuts, but flattened,
which could be made to roll over the larger tumour very dis-
tinctly. Although she complained of great pain in the seat of
the large tumour, yet she did not experience much uneasiness
when it was pressed upon, but the shghtest examination of the
smaller growths caused her considerable suffering.
The hver was enlarged, and pressure over its region caused
pain ; her bowels were moved daily, and occasionally with her
motions a sanious fluid was mixed; her urine was clear, and
she stated that at no time had it been mixed with blood.
There was considerable irritability of the stomach, the tongue
was morbidly red, the papillaB elongated; she was restless,
worn out with pain and loss of sleep, and her pulse was quick,
small, and irritable.
She was ordered, — MorphisB acetat. gr, ss., o. n. et p. m. ; with
sod. sesquicarb. gr. x. ter die in aqua month, virid. The pills
gave her rehef , the irritability of stomach subsided, but the tumour
rapidly increased; the lower extremities became enormously
enlarged from serous infiltration ; this reached to the abdominal
integuments, and into the abdominal cavity itself a large quantity
of fluid was effused. In the course of a few days, symptoms
of effusion into the cavities of the pleurae mamfested them-
selves ; and, after enduring with heroic fortitude her aggravated
sufferings, she expired on the morning of July 24.
The body was examined eighteen hours after death. The
integuments of the abdomen, upper and lower extremities,
were glossy, distended, and oedematous.
Thorax. — (Right side). About sixteen ounces of yellowish
fluid were effused into the cavity. The posterior surface of the
middle lobe of the lung was hepatized ; in the apex of the
upper lobe there were a few scattered tubercles. (Left side).
Some slight but old adhesions existed in the upper part of the
cavity, and in it were about eighteen ounces of sanguinolent
serum. In the apex of the lung, also, there were some crude
tubercles. The pericardium contained four ounces of hghtish red
serum. The heart was small, oedematous, flabby, and readily
lacerable ; its valves were healthy.
Abdomen. — The liver was large, about twelve lbs. in weight,
universally infiltrated with tubercles varying in size from that
of a pea to a small apple. They presented the true cerebriform
character. The gall-bladder was large, and distended with
thin greenish bile. The pancreas was large, and firmly fixed ;
its tissues were infiltrated with fungoid tubercles varying in
size. The spleen was healthy; the stomach small, but free
from disease ; the small intestmes healthy, the large intestines
small and empty. The mesenteric and meso-colic glands were
RARE MALIGNANT DISEASE OF THE OV AHY. 163
enlarged, and affected with the cerebriform disease. The right
kidney was pale and granular. The uterus was healthy.
The right ovary had on its anterior aspect one tubercle about
the size of a small shot.
The tumour which had attracted attention during life had
emanated from the left ovary ; it had surrounded and com-
pressed the left kidney, which was small, pale, and granular,
and had ascended behind the transverse colon as high as the
inferior curvature of the stomach. On making a section, it
presented the characters of true cerebriform cancer. The
moveable tumours that could be distinctly felt on the surface were
developments of the disease in the omentum.
The head was not examined.
Case 2. — Miss T. , aet. thirty-six, of dark sallow complex-
ion, whose occupation in life has been that of a governess, was
seen by me on the evening of January 19, 1844. She was much
exhausted by a journey of seventjr miles ; and prescribing some
moderate stimulant, the investigation of her case was adjourned
nntil the following day. For five months she complained of
difficulty in passing her urine, and a constant desire to micturate,
attended with pains during the passage of the water, as well as
occasional heavy pain above the pubes and in the left iliac region.
During the first two months of her illness her catamenia appeared
at the proper time, but for the last three periods they have been
suppressed. The medicines prescribed by her attendant failing
to relieve her, he instituted a vaginal examination, and discovered
a tumour which he pronounced " ovarian."
The patient was thin and sallow, her conjunctiva blanched,
her pulse small and quick, the action of the heart was readily
excited, the respiration regular and normal. The abdomen ex-
ternally was flat, the parietes very thin ; and in the left and
inferior part, extending firom the left iliac region to above the
pubes, a sohd, hard, oblong tumour could be lelt, about the size
of a duck's egg, irregular on its surface, and very moveable,
obeying the impulse of the hand, as well as changing its situa-
tion according to the position of the body. Per vagincmt this
tumour could very readily be felt at the upper and left side of the
uterus, so that its thickness could easily be estimated by one
finder in the vagina and another on the surface of the abdomen.
When the tumour was depressed in the pelvis by the hand placed
upon the abdomen, the uterus as well as the tumour protruded
into the vagina ; but still the uterus could be moved independently
of the tumour itself, showing their want of connexion, or rather
that, if attached, the connexion was not intimate. The os uteri
was small, and the attempt to introduce the uterine bougie caus-
ing much pain, its employment as a means of diagnosis was de-
sisted from. The catheter passed into the bladder found this
164 RARE MALIGNANT DISEASE OF THE OVARY,
yiscus small, and, as the abdominal parietes were very thin, the
pomt of the instrument could be felt anterior to and below the
tumour. The urine was muddy when drawn off ; it became
perfectly clear on boiling. Per rectum the uterus could be felt
rather large, as also the tumour pressing upon the bowel and
diminishing its calibre. (The bowels were usually constipated,
and she had suffered from hemorrhoids.) She complained of
great numbness and pain in the left thigh and leg, which she
stated was occasionally swollen, but when examined it was not
found to be larger than the right. The pain and numbness were
increased by lying on the left side. The treatment prescribed
consisted in the administration of sedatives to allay pain, stimu-
lating tonics, and a due supply of bland nutriment ; but she be-
came more and more exhausted, and died about mid-day on the
30th January.
Permission was given to inspect the abdomen, which was done
about twenty-six hours after death. It was tense from tympan-
itic distention, and indistinct fluctuation could be readily felt.
On opening the parietes, about one pint and a half of straw-
coloured serum wa§ found in the cavity ; there were no traces of
either old or recent peritonitis. At tne lower part of the abdo-
men, on the left side, rising from the pelvis, a tumour came into
view, of a yellowish-gray colour, its surface nodular and irregu-
lar, tolerably firm in its texture, and very moveable. It was
anterior to the left Fallopian tube, but not connected with it ;
the left ovary was lost in the development of the tumour. On
making a section, numerous light-coloured lines could be seen,
showing its cystiform character ; and the section in some places
presented a lemon-yellow colour, in others it gave a reddish ap-
pearance. When the section was made, a considerable quantity
of thin yellowish fluid was poured out. Several of the nodules
on the surface of the tumour were examined ; some were solid,
but the exterior membrane or cyst was of a lighter colour than
the interior ; others consisted of a capsule, more or less thick,
containing fluid varying in density and colour from a light lemon
to a dark brown, and from the fluidity of serum to the thickness
of treacle. When the uterus was drawn upwards and forwards
from the cavity of the pelvis, a similar tumour on the right side
came into view, globular in form, but with an irregular surface,
similar to the tumour on the left side. It also had no connexion
with the Fallopian tube ; but the ovary itself was lost in the
structure of the tumour. The uterus presented no abnormal ap-
pearance ; it was large for a virgin organ, and some of the muci-
parous glands of the cervix were prominent.
The stomach, large and small intestines, were distended with
flatus, pale in colour, and their coats remarkably thin. The
liver was pale, wrinkled by tighulacing, a7id throughout affected
with encephaloid cancer. The spleen was small ; the pancreas
CHRONIC DISEASES OF THE STOMACH. 165
healthy ; the kidneys large, flabby, and pale. The mesenteric
and meso-colic glands were all enlarged ; some were soft, as if from
tubercular degeneration; others were firm, presenting a yellowish-
ted colour on diyision ; whilst a third class, when a section was
made, showed a surface firm in some spots, soft and cerebriform
in others.
Permission was not given to inspect the other cavities.
A microscopical examination of the morbid structure was made
by Mr Birkett, demonstrator of anatomy at Guy's Hospital, and he
reports : — " The mass was firm but easily lacerable, containing
opaque and somewhat translucent material, apparently cystiform.
It consisted of single and double nucleated cells, with bicaudate
cells. A considerable quantity of fibre was present."
Practical Observations on some of the Chronic Diseases of the
Stomach, generally known by the symptomatic Nam^es of Car^
diaigia, Gastrodynia, Pyrosis, Neuralgia, cj-c. By William
Strange, M.D., M.R.C.S. Edin., Surgeon to the Ashton-
under-Lyne Dispensary.
Chronic disorders of the stomach and other digestive organs,
arising either in consequence of existing organic disease, or of
what IS often erroneously called functional derangement, present
themselves so commonly to the observation of the medical prac-
titioner, and so much has been written upon their pathology and
treatment, that it would be almost impossible to advance any
thing new or striking upon the subject. Dr Abercrombie, with
many other authors of modern date, as Andral, Barras, Johnson,
Paris, and Wilson PhiUp, have given us a collection of cases
and observations which may be said to include amongst them
every phase and character which this protean disease can assume.
Neither is there a greater paucity of remedies — ^prophylactic,
dietetic, and curative — ^than the immense variety of dyspeptic
affections would lead us to wish for. Scarcely an article of the
materia medica but has either been sanctioned by long usage,
or been recommended by the sanguine eulogiums of individual
practitioners, as serviceable in some one or all of these affections.
We should omit many were we to enumerate all the vegetable
bitters and tonics, purgatives and emetics ; the alkalies, alkaline
earths, metallic oxydes, salts of iron, copper, zinc, bismuth, and
arsenic; mineral acids and waters; galvanism, hydropathy,
homoeopathy, &c.
It would be merely idle, therefore, to occupy space devoted
to the advantage of the profession with such a subject, were it
not that, notwithstanding this richness of detail, and vast amount
of detached and isolated observations, there is a great want of
166 CHRONIC DISEASES OF THE STOMACH.
connexion between the therapeutic and the pathological know-
ledge of gastric diseases preyalent in the profession, and which
leaves a hiatus in the chain of observation most embarrassing in
practice. It is having felt the want of appropriation of the
remedy to the particular character of the disease, which first
led me to pay particular attention to this subject ; and I feel
confident that success in the daily treatment of these most com-
mon ailments can only be arrived at by careful observation of
the different varieties of dyspeptic disorder, coupled with a
patient and extensive application of therapeutic agents and thera-
peutic knowledge, based upon sound physiolo^caJ theories. The
young practitioner, until he has made a classification (at least in
his own mind) of gastric disorders, will be constantly puzzled in
his choice of remedies, and the more so, as a thorough knowledge
of their therapeutic actions is only to be obtained by long obser-
vation and repeated failure and aisappointment.
To those practising in the midst of a dense population in
large towns, particularly if they be mercantile or manufacturing,
stomach disorders are every day presenting themselves. The
observations I am about to make are based upon personal
attention to more than 1600 cases, of more or less serious
character, occurring in a period of a few years.
Most of the works on indigestion which have issued from
the press of late years are samy deficient in what I have above
stated to be so necessary in practice, viz. a classification of the
varieties of the disease, and a correct definition of the several
pathological conditions upon which they depend. Without
something of this kind the treatment of gastric disorders must
be mere empiricism. If a proper division, founded upon the
essentially distinct morbid conditions in the coats or fluids of the
stomach had formerly been made, the now exploded doctrine of
"gastrite chronique" would not have been applied to all the
derangements of the digestive apparatus ; nor such fatal practice
as the indiscriminate use of tlje lancet, leeching, counter-irrita-
tion, and mercury, have been resorted to, — ^means which, in five
cases out of six, I conceive to be not only useless but highly
prejudicial.
Dr Abercrombie, however, in his excellent little work on the
pathology of the stomach, and Andral, Barras, and others, have
many observations of great value, showing the error of referring
all painful affections of the stomach to a chronic inflammation ;
and the first author has thrown out some useful hints for a
classification of these disorders, founded chiefly upon the nature
of the pain and the period of its attack. He urges the necessity
of a classification of the varieties, in order to a satisfactory ap-
plication of the therapeutic and dietetic means of remedy. In
attempting to separate the different varieties of gastric disorder,
I shall foUow as much as possible a natural method, both as to
CHRONIC DISEASES OF THE STOMACH. X67
the severity of the symptoms and the succession of the attack,
when, as often happens, seyeral yarieties, each increasing in
intensity, follow each other in a regular train of symptoms,
constituting what may be called the most aggrayatea form of
dyspepsia. I shall confine myself on the present occasion to
remarks on those affections which are not necessarily dependent
upon organic disease or cacoplastic action, but are generally
(although erroneously) ascribed to functional derangement of the
stomach. Such a mode of viewing the following class of
disorders is, however, at best but doubtful ; and I feel convinced
that the more advances we make towards a correct knowledge
of the nature of these affections, the more we shall find them to
be dependent upon structural or organic, although not permanent,
changes. An appreciable alteration in the structure and appear-
ance of the mucous membrane, of the muscular coat, or of the
vessels and nerves of the stomach, such as thickening of the
mucous membrane, pale and flabby state of the muscular sub-
stance, varicose state of the veins, &c., are as much appreciable
organic changes as are inflammation, ulceration, or scirrhus.
Without denying the existence of any form of chronic (or
fonctional) derangement of the stomach which may not be
allocaited to some one of the following divisions, and allowing
that they may and often do run into each other in such a
manner as to make it difficult to say to what patholo^cal
conditions the symptoms are to be attributed, the attentive
practitioner will have no difficulty in distinguishing the follovring
principal varieties, all of which have several forms.
1^9 Dilatation, torpor, or, to speak with more precision, atony
ofthest(»nach.
2dy Atony with morbid irritability.
Sd, Acute irritation.
4thy Neuralgia, generally accompanied with pyrosis, to which
the name of gastralgia might perhaps be more properly restricted.
5thy Chronic gastritis.
Each of the above varieties I have many times been able to
distinguish as a distinct and separate attack, although two or
more of them are often met with coexisting, and pyrosis is in
some measure met with in all of them. Generally, however,
the order of succession, where an individual presents several
varieties at once, is atony, morbid irritation, or else neuralgia,
and then chronic gastritis ; the persistence of which last may
remduce any of the former varieties.
l«f. Atony of the stomach. — This kind of gastric affection, so
common amongst the crowded population of manufacturing towns,
presents the following symptoms and physical signs : — The
tongne is large, flat, and mbby, filling the whole width of the
mouth, its surface almost uniformly pale and without scurf, pre-
senting the appearance of boiled veal or muscular fibre which
^ been macerated in cold water ; the face pale and flaccid.
168 CHRONIC DISEASES OF THE STOMACH.
corresponding remarkably with the tongue; the epigastrium
distended, not painful, but uneasy on pressure ; the abdomen in
women often pendulous and flabby, sometimes hard and tender ;
the pulse is generally unaffected, or it is weak and small.
Patients affected with this form of disease complain that they
have no appetite, or that they crave for things which are to
them indigestible. Immediately after even a hght meal, they
experience a feeling of distention which compels them to loosen
their dress, and maS:es muscular exertion exceedingly distressing.
There is not often any very acute pain in the region of the
stomach or along any part of the digestive canal ; but some*
times to the sense of fulness succeeds a constriction about the
lower part of the epigastrium, accompanied by eructations of
gas sometimes mixed with acidity. There is flatulence, with
irregularity of the bowels, a general state of costiveness being
occasionally interrupted by a painful diarrhoea. A feeling of
constriction, with pain extending through to the back, coming
on two or three hours after meals, may be owing, as is supposed
by Dr Abercrombie, to irritation created in the duodenum by the
passage of insufficiently digested food into that bowel ; and I
have remarked that this pain very frequently coexists with a
relaxed state of the bowels and painful motions. On the whole,
however, a feeling of acute pain coming on periodically some
hours after a meal is much more frequently met with in another
well marked form of gastric disorder, viz. where the tongue ex-
hibits a degree of redness round the edges, with furred centre ;
and where there is pain on pressing the epigasti'ium, denoting
an irritable state of the mucous and muscular coats of the
stomach. In consequence of the uneasiness and pain which are
occasioned by all heavy articles of diet, persons affected with
an atonic state of the stomach generally live upon slops, such as
tea, milk, gruel, porridge, &c., substances which from their bulk
tend to increase the previous distention, easily run into chemical
changes, and are destitute of those stimulant properties which
are necessary to arouse the torpid or diminished contractility
of the stomach. Although opportunities of dissection are but
seldom afforded us when the disease has not proceeded beyond
this the least severe form, yet post-mortem exammations have often
exhibited a pale, flabby, and distended state of the coats of the
stomach, which has coexisted with the foregoing symptoms ;
and this, with our knowledge of the action of the stomach in the
process of digestion, together with analogous affections of other
hollow organs, warrant the conclusion, that a want of tonic con-
tractile power in the muscular substance of the stomach is the
real essence of this disorder. The flabby and pale tongue, the
distended abdomen, with a sluggish state of the bowels, and pale
skin, all denote a corresponding deficiency of vital power in all
the organs of the body.
Accordingly, we are not surprised to find this variety of dys-
CHRONIC DISEASES OF THE STOMACH. 169
pcpsia extensively prevalent amongst the inhabitants of lar^o
towns, particularly if the population be employed chiefly in
crowded workshops and manufactories. The want of ventilation,
the dust, smell, and uniform warmth of cotton factories especially,
but principally the absence of the stimulant and invigoratii^
properties of fresh cold air, are, in my opinion, the very predis-
posing causes most certain to induce this affection. Sedentary
habits, with insufficiency of out-door exercise, too, undoubtedly
produce the same condition of the digestive apparatus in the
middle and upper classes of society.
Such being one of the commonest derangements of the stomach
for which the practitioner is called upon to prescribe, it is essential
to make choice of those remedies which possess at once a tonio
and stimulating, but not sedative and enervating property.
Were he, instead of doing so, to haye recourse to antiphlogistic
treatment, bleeding and counter-irritation, the patient would go
from bad to worse, and a most intractable irritability of the
stomach would be brought on, leading in all probability to
organic and incurable disease. With the view of reducing the
imtation, if any, and of gently stimulating the stomach, I haye
for a length of time mainly depended upon one substance, viz.
the oxide of bismuth, which has also been highly extolled by
Dr Paris and other authorities. When cases to which it is ap-
plicable are selected, I believe that not one in ten cases will
occur in which much benefit will not be procured from its use.
The manner in which I prescribe it is as follows : —
R. Bismuth, trisnitrat. . 5j-
MorphiflB muriat. . . gr. ss. — -j.
AcacisB muciL . • . ^ij*
Syrup, zingiber.,
Tinct. car(mm. com. ana, . 3iij.
Infus. cascarill. . §v. M.
5j. ter die.
This formula retains its appearance for a length of time ; the
mucilage suspending the bismuth in such a manner as to give
to the mixture the consistence of cream. In pyrosis taken at
the period of attack, and in that form of gastrodynia previously
described, taken half an hour after meals, it immediately assuages
the pam and promotes digestion. Whether the bismuth acts aa
an astringent, or as a tonic and stimulant, I know not ; but in
those cases particularly which will be hereafter described,
where there is considerable derangement of the duodenum, this
medicine acts like a charm.
Undoubtedly much benefit may be often obtained from the
vegetable bitters with alkalies, and from the preparations of
quinine and iron, particularly the sulphate and ammoniacal
citrate, and from mineral waters. The good effect, however, of
direct tonics I have always found most evident after the more
Y
170 CHRONIC DISEASES OF THE STOMACH.
distressing symptoms have been removed by a perseverance for
a short time in the above formula.
All kinds of fermented and spirituous liquors, as they debili-
tate as well as stimulate, are injurious in this affection. Purga-
tives must not be resorted to for the relief of the costiveness
which so often accompanies this form of dyspepsia, as bv over-
exciting they afterwards debilitate the intestines. Gentle laxa-
tives with tonics, such as small doses of aloes or colocynth with
sulphate of iron, as recommended bv Dr Abercrombie, or with
sulphate of zinc, are the most beneficial.
2d, Atonic morbid irritability of the stomach. — ^Although
a simple state of deficiency in the vital power or tonic contractiUty
of the coats of the stomach often exists alone and uncomplicat^
with any other derangement of the digestive apparatus, yet it
appears that when timt state has existed for some length of
time, symptoms of morbid irritation set in, and either supersede
or obscure the earlier symptoms. Consequently I look upon
this second form of dyspepsia as the natural consequence of a
long continuance of the former atonic variety. Nevertheless
there are numerous cases to be met with, in which there have
been induced symptoms which indicate the existence of more or
less acute morbid irritation of the mucous membrane lining the
stomach and duodenum, without there having previously existed
any trouble in the digestion which could lead us to suspect any
derangement of the tonicity or innervation of those organs.
Indigestible articles of food, affections of the mind, pressure
upon the stomach, and bad living, are common causes of morbid
irritation of the gastric mucous membrane.
The symptoms indicating this affection differ considerably
from those characteristic of mere want of tone. The tongue
is generally slightly red at the tip or round the edges ; there is
a thin whitish fur all over the centre which cannot be scraped
off; a sense of heat in the throat, oesophagus, and sometimes in
the stomach. The sleep is often disturbed, and muscular efforts
are weakened. The appetite is always uncertain in this affection,
following the remissions and exacerbations of the attacks.
There is a general desire for savoury and solid food, although
this almost invariably aggravates the symptoms. There is
pain in the stomach durmg the whole time the food remains
there, which is sometimes relieved by vomiting coining on from
half an hour to three or four hours after a meal. Substances
in small quantity are seldom returned. In some cases there is
a sense of weight only at the stomach, until about two hours
after taking food, when a sense of pain and constriction ensue,
which lasts frequently until relieved by a relaxed but unsatis-
factory motion. In these cases it has been no doubt rightly
supposed that the irritable stomach pushes onwards the partially
digested food into the duodenum, whence it is either forced
back by vomiting, or passes out of the bowels, after giving
CHRONIC DISEASES OF THE STOMACH. 171
pam in its whole course, in a partially relaxed and often scalding
motion. This morbid irritation of the stomach is sometimes
accompanied by a degree of pyrosis, but not by any means in
a constant manner. The regurgitations are more frequently
composed of the mucus of the stomach mixed with acidity, gas,
and the aroma of the food. We meet with pure cases of
Eyrosis, where a large quantity of a transparent water, called
J the patents water-tomes, or in other instances of a glairy al-
buminous fluid, is pretty regularly ejected from the stomach after
a paroxysm of severe neuralgic pain ; more constantly in another
form of gastric disorder, viz. that in which the pam is not so
constantly excited by taking food into the stomach, but comes on
in a periodical manner at certain hours of the day, or after an
interval of one or two days, or a longer period. This form I
shall afterwards advert to under the designation of neuralgic
irritation of the stomach, or gastralgia.
The medical treatment of chronic morbid irritation of the sto^
mach will depend very much upon the previous duration of the
disease, its complication with other morbid conditions, and upon
the general state of the patient's constitution. When the dis-
order has not arrived at any very troublesome height, a similar
treatment to that recommended n)r atony of the stomach will be.
found to answer very well. In more exaggerated cases, how-
ever, and especially if there be much pain and heat at the epi-
gastrium, it will be well to begin with moderate counter-irritation,
as a blister, two or three mustard poultices, or the ung. antim.
tart. All drastic purgatives, particularly mercurial ones, should
be avoided, as they mcrease the irritation. The oxide of bis-
muth, with infusion of rhubarb and magnesia, will be found to
answer the double purpose of maintaining a steady action upon
the bowels, and of correctiuj^ the acidity and heat of the stomach.
The following is a good formula :
R Bismuth trisnitrat. . . 3j.
Magnes. carb. ... Sss.
Tinct. hyoscyami . . 5iij-
Infus. rhei; .... gviii. M.
One ounce of this mixture to be taken three or four times a-day*
After the more acute symptoms have been reduced, the mixture
of bismuth with gentle stmmlants and tonics, as prescribed for
the atonic state, will answer well ; and, finally, we may have
recourse to quinine, iron, zinc, and other direct tonics.
Should there be much acidity with regurgitation some time
after taking food, accompanied with a costive and unsatisfactory
state of the bowels, the following pill taken regularly after the
principal meal will be found very useful :
& Aloes in pulv. . . gr. iss.
Ferri sulph. . . • gr- ij;
Sapon. dur. . . gr. vi. M.
Div. in pill. ij. simul sumend.
172 ON PERlTYPHLtTIS.
The soap is a great addition to- the aloes and iron pill in com-
mon use, as it unites chemically with the free acid of the stomach.
I must reserve the dietetic treatment of these two varieties of
gastric disorder for a future occasion.
(To be eontinuedJ)
Ashtoh-ukdea-Ltke.
On Perityphlitis, or Inflammation of the Cellular Tissue adja-
cent to the Coscum. By William Seller, M. D., &c., one
of the Physicians to the Royal Dispensary, Edinburgh.
It is now fifteen or twenty years since the attention of the
medical profession in France and Germany was first drawn to
the not unfrequent occurrence of inflammatory turgescence ad-
jacent to the coBCum, and yet the subject has hardly been adverted
to in the most recent systematic works published m this country.
The only work indeed of this description in which I have met
with even a cursory notice of this inflammation, under the name
of Pericoecal Inflammation, is Copland's Medical Dictionary.*
No doubt Mr Syme seems to point to this kind of inflammation
in a few lines devoted to iliac abscess.f But that term is not
specific enough to denote the disease which I am going to de-
scribe ; and, as he speaks of the treatment by an early aperture,
and regards the disease as of most frequent occurrence after
parturition, I am inclined to think that the cases on which he
founds must have been of a different character from those which
come strictly under the head of Perityphlitis or pericoecal in-
flammation. Cases are recorded of this form of inflammation
which show the evil effects of rash interference with the lancet ;{
and Dupuytren expressly says, that in his experience males are
much more liable to it, under all circumstances, than feinales.§
The name Perityphlitis is used by Dr Albers in a memoir on
coecal inflammation, and, though somewhat pedantic, I have
adopted it for want of a better. || My attention was first drawn
to tnis disease several years ago ; and the following account is
founded on cases which I have myself seen, as well as on a care-
ful study of the detached memoirs which have been published on
the subject.
The disease in question is of an acute though insidious charac-
ter, has its seat external to the peritoneum, in textures of a cellu-
* See Coecum.
t Principles of Surgery, p. 328.
$ Dupuytren, Le9on8 Orales de Clinique Chirurgicale, tome iii. pp. 343, 345.
§ Ibid. p. 336.
II Histoire de rinflammation du Caecum (Typhlite), par J. Fried. Herm. Albers,
Froiesseur de M^dedne A 1* University de Bonn. Traduit par J. B. Pign6; Ency.
dographie des Sciences M^dicales, tome x. (1839), p. 181.
ON PERITYPHLITIS. 173
lar structure^ and, unless neglected at first, is more prone to re*
solution than to the formation of pus ; when suppuration does
occur, the pus is almost invariably evacuated by the rectum.
Tenderness on pressure, hardness, dulness on percussion, and
circumscribed swelling of the abdomen, adjacent to the anterior
part of the crest of the right ilium, while the integuments move
freely over the tumour, are the prominent and least variable
symptoms of this disease. In extent, the part so affected varies
considerably. But when, as happens sometimes, the swelling
reaches across the abdomen towards the linea alba, or upwards
obliquely towards the umbihcus, the disease should be suspected
of having lost its original singleness of character, and of having
passed into an inflammation of the peritoneum, or even perhaps
of the coats of the bowels.
Pain of the upper part of the thigh in front, increased on
motion, is either not a constant symptom, or is so trivial in the
majority of cases as to have escaped the notice of most observers.
In the cases which I have seen it was present, though not re-
markably severe ; and in that with the particulars of which I
am best acquainted, it was the pain rismg upwards from the
thigh which first led to the discovery of the real seat of the dis-
ease. Probably the function of the bowels is never altogether
unaffected; yet the degree in which intestinal disturbance is
present has a wide range. In the case first referred to, of which
a short report will be given hereafter, with the exception of coHc
pains, rather severe for two or three hours, the bowels were
positively unaffected in their functions ; there was not the slight-
est accumulation of feculent matter, and there was nothing that
could be called constipation. On the contrary, in a case which
I saw under Dr J. Duncan's care last winter, also to be noticed
hereafter, the obstruction of the bowels could not be overcome
by any means, and the event was fatal, apparently in connexion
with this cause. In the major part of the cases reported by the
original authorities on this subject — Husson and Dance, as well
as by Meniere, and in most of the additional cases given in Du-
puytoren's *' Logons Orales de Clinique Chirurgicale" — ^though
all of these are not simple cases of this affection, constipation
and colic pains were present until the remission of the disease.*
In a few mstances diarrhoea preceded the attack.
Nausea, vomiting, and anorexia are sometimes among the
symptoms, but are by no means essential features of the disease.
Symptomatic fever is not usually very well developed ; in the
simpler cases the pulse is natural or but shghtly accelerated ; in
* Husson et Dance, M^moire sur quelques Engorgements Inflammatoires dans
la Fosse Iliaque Droite : Repertoire G^n^ral de Clinique Chinirgicale, tome iv. p. 74.
Paris, 1827. Meniere, Sur des Tumeurs Phlegmoneuses dans la Fosse Iliaque Droite :
ArdiiYcs Oentfrales de M^decine, tome xvii. pp. 188, 513. Ao6t, 1828. Dupuy-
tren, Leyons Orales, tome iii. p. 330, Des Abces de la Fosse Iliaque Droite.
174 ON PEKITYPHLITIS.
the severer, sharp, hard, or jarrmg, not often small or oppressed,
as in inflammations of the intestines.
The disease is apt to come on insidiously; the colic pains
which most commonly usher it in may last only for a few hours,
or may recur at intervals for several weeks, before the swelling
appears. The disease is of uncertain duration — chiefly, however,
owing to the unequal periods over which the precursory symp-
toms are spread. When the precursory period is short, the
disease uncomplicated, and the treatment appropriate, a cure
maybe looked for in ten or twelve days from the commencement.
A degree of induration, however, occasionally remains, which,
though not dissipated for some time, gives but Uttle inconvenience.
There is observed in some patients a disposition to the recur-
rence of the disease for a longer or shorter period after it has
subsided. In one person it occxu'red three times within a period
of sixteen months. But this is not the usual course of the dis-
ease. In the experience of Dupuytren, it is stated to have been
ascertained, that after having suffered from this inflammation,
one person remained in perfect health for sixteen years, another
for nine years, and a third for eight years.* It would be sur-
prising if a malady of this nature should not be sometimes com-
plicated with permanent abdominal disease; but the complete
and rapid recovery in most cases, even under unfavourable cir-
cumstances, should preclude the idea thrown out by some autho-
rities that it is generally connected in its origin with mucous
inflammation in the adjacent parts of the intestine.t
The unfavourable terminations of this disease are suppuration
and extension of the inflammation to the peritoneal lining of the
abdomen, and even to the coats of the intestines, the latter ter-
mination being a supposition rendered sufficiently probable, but
not yet confirmed by adequate evidence.
In the " Logons Orales " of Dupuytren, the disease is termed
abscess, and all the cases detailed terminated by suppuration ;
which might lead one to infer that resolution is a less common
result than suppuration. The contrary of this is proved by
reference to the other memoirs on the subject, with the excep-
tion of that of Albers, who erroneously represents suppuration
as the most frequent termination ; but the following passage
from the " Le§ons Orales " shows that Dupuytren did not regard
suppuration as the most frequent termination : " Dans un grand
nombre de cas, elles se termment par resolution ; dans quelques
circonstances, par ime abondante suppuration ; quelquefois enfin
elles sent le point de depart d'une inflammation qui s'etend h
toute la surface du peritoine."J In the memoirs referred to
• Rdperloire, tome iv. p. 86. f Dupuytren, Le9ons Orales, tome Hi. p. 336.
$ lb. tome iii. p. 331.
ON PERITYPHLITIS. 175
there is no attempt to give the statistics of this disease ; yet, not-
withstanding that seyere and fatal cases are commonly chosen
for report, we find three cases of resolution recorded by Dance
and Husson, and seven by Meniere.
But even the termination by suppuration, as in the case of
abscess of the pelvis after parturition, is for the most part unat-
tended with serious consequences.* To the pelvic inflammation
after parturition, the disease under consideration has manifestly
a considerable analogy. Yet active treatment in the early stage
is plainly more essential than in the pelvic inflammation ; for
the tendency to suppuration seems to be exactly proportioned
in this disease to the neglect of free evacuations of blood, even
by venesection, on the first onset of the inflammation.
In a case in which twenty-two days were allowed to elapse
from the first attack of pain in the right iliac fossa, and fourteen
days from the discovery of swelling in the same place, before
treatment was resorted to, pus was evacuated by stool, and at
the same time the tumour in the ccecal region disappeared, and
the patient recovered.f
In another case, a young man, aet. twenty-six, was admitted
into the Hotel Dieu, who had suffered for several days be-
fore from dull pain, tension, and swelling in the right iliac fossa.
There were colic pains at intervals, and the bowels were consti-
pated ; the pulse was unaffected. Six days thereafter, during
which a few leeches were applied, and some inefficient refriger-
ant and emollient treatment practised, acute pains arose, spread-
ing over the abdomen ; next day there was great tenderness on
pressure, and the pulse was frequent, small, and constricted.
Venesection was resorted to, and numerous leeches were succes-
sively applied. In seven days from the occurrence of acute pain
the symptoms remitted, and m five days more obscure fluctuation
was discovered in the right iliac fossa. On the following day
a discharge of pus commenced from the rectum, which contmued
for six <Eiys, while the swelling by degrees subsided. The
patient was finally dismissed quite cured.J
In this case the swelling in the right iliac fossa, which was
Eesent some days even before he was admitted into the Hotel
ien, appears to have been overlooked at first, or held of trifling
consequence ; and it is probable that a somewhat greater activity
of treatment in the early stage would have prevented at once
the peritonitis which, beyond question, arose six days after his
reception, and the suppuration into which the original disease
Three cases besides are reported by Husson and Dance, in
which suppuration occurred, and yet recovery took place, the
* See Periscope of June Number, p. 156.
t Meniere, Archiyes Gtfn. de Mtfd., tome xvii. p. 200.
j Husson et Dance, Repertoire, tome iv. p. 80.
176 ON PERITYPHLITIS.
pus being in every instance evacuated by the rectum ; and in
these three cases active treatment was either not practised at
all, or not till a late period of the disease.* And in Meniere's
memoir there are five cases of recovery reported after the dis-
charge of pus by stool, on nearly all of which the same observa-
tions as to the delay of proper treatment may be made.f In
Dupuytren's " Logons Orales" a similar case is recorded, in
which recovery took place after the evacuation of pus bv stool ;
the patient was received into the Hotel Dieu on the nfteenth
day of his illness, and pus was observed in his stools on the day
of his reception ; leeches had been applied and venesection had
been once practised before he came to the hospital, but at what
period is not stated.
The same work contains a case cited from Ouvrard, which
shows that tumours of this kind should not be unadvisedly
opened. A man of twenty-eight years of age was affected with
vomiting for six days, and then a phlegmonous swelling was
discovered in the region of the coecum. At the end of three
weeks pus was passed by stool. Some swelling remained" (as is
not uncommon), and the surgeon, wishing to evacuate its contents,
opened the abdomen without finding an abscess, and penetrated
into the coecum. The wound was closed. The health quickly
declined, fever, looseness, and general emaciation followed. At
the end of six months, after a journey in a rude carriage, an
abscess pointed below the cicatrice, and soon opened spontane-
ously, discharging pus and feculent matter. By means of ap-
propriate applications, compression, rest, and a strict regimen, a
cure was accomplished after the lapse of eight months.^
It seems certain that the pus formed in perityphlitic inflam-
mation sometimes, though very rarely, penetrates through the
abdominal wall ; yet it is not to be inferred at once that every
discharge of pus through an external aperture in this region
arises from such an inflammation, since pus formed at a distance,
or what is termed a congestive abscess, may be evacuated in
this region. No case of this mode of evacuation, however, is
reported in the two principal memoirs on this disease,— either in
that by Husson and Dance, which contains eight cases, or in
that by Meniere, which contains thirteen cases. The following
case, reported in the " Le§ons Orales," seems to be unequivocally
an instance of the termination of perityphlitic inflammation in an
external opening, since pus was first discharged by stool. A
young man of twenty-four years of age was treated at the Orleans
Hospital for a phlegmonous tumour in the right iliac region,
which he had at first neglected. He passed pus by stool, and
his health was partially restored. He then went to Paris, where
* Husson et Dance, Rtfpertoire, tome iv. p. 80.
t Meniere, Archives Guncrales, tome xvii. p. 200-207. J lb., pp. 343, 344.
ON PBRITYPHUTIS. 177
his complaint increased, the swelling enlarged, and abscesses
opened in the right ihac region of a fistulous nature, through
wiiidi pus and feculent matters were discharged. After a
tedious illness of several months, accompanied with cough,
diarrhoea, emaciation, and CBdema of the lower extremities, and
after being several times on the point of sinking, he recovered.*
In the cases which prove fatal, no evacuation of pus either by
the rectum or by external opening for the most part takes place ;
but a copious deposit of pus is found on dissection almost uni-
formly, I think, as far as the reported cases show, along with
marks of extension of the inflammation to the peritoneum. A
case of this kind is reported by Meniere. A young man, twenty-
four years of age, subject to colic pains and purging, was re-
ceived into the Hotel Dieu ten or twelve .days after he had
been attacked with a dull pain in the right iliac region. No
treatment had been practised. The tumour in the right iliac
region was not very prominent, but very painful on pressure.
The constitutional symptoms were rather severe. Leeches were
applied on three successive dajrs with percei)tible relief. On
the evening of the fourth day violent colic pains came on, the
stools were frequent, and there was great tenderness on pressure
all over the abdomen. The fever was intense, the patient com-
plained much, was excessively restless, and much changed in
aspect. The swelling had extended, and its border was no
longer discoverable. On this day venesection was practised, and
forty leeches put on. The next day thirty leeches were ap-
plied, all without effect, and death took place on the 8th day.
On dissection, general peritonitis was found involving the omen-
torn and peritoneal coat of the sniall intestines. The ccecum was
detached with the greatest ease from the iliac fossa. The
cellular tissue lining that region was charged with a yellow
almost concrete pus. This ii^tration ascended to the level of
the right kidney, and extended into the pelvis around the
bladder and rectum, and traces of it were met with even on the
left side. The cellular layer which unites the peritoneal coat of
the intestines to their muscular coat was equally softened, and
on seizing a convolution of the ileum, it was easy to strip off its
outer coat.
The case before referred to, which I saw under Dr J.
Duncan's care last winter, had a similar course, though, as an
inspection of the body was not permitted, we are left to con-
jecture as to the exact state of the disease at the time of death.
The patient was a female servant of twenty years of age. In
the beginning of December 1843 she was seized with pretty
severe pain m the right iliac region, attended with vomiting.
Next day, a medical man, regarding the case as one of colic, pre-
• Lejons 0;ales, to.ne iv. pp. 342, 343.
178 ON PERITYPHLITIS.
scribed assafoetida pills, which were taken without relief, and he
did not return. On the fourth day Dr Duncan saw her. She
then complained very much of pain in the right iliac fossa.
The vomiting had ceased for the last twelve hours. Pressure
over the seat of the pain gave considerable uneasiness, and a
slight degree of fulness was perceptible. The bowels had not
been moved fi*om the morning of the first attack. Pulse 100,
rather full ; skin rather warm ; tongue pretty clean.
As the case seemed to be one of inflainma.tion around the
ccDcum, twenty-five ounces of blood were drawn from the arm,
with the effect of affording some relief. Two grains of calomel
with half a grain of opium were ordered to be taken every three
hours. The next day the fulness was much more perceptible ;
a tumour in short could be distinctly defined in the region of the
coecum, and traced up into the lumbar region, while there was no
feneral distention of the abdomen. " Some evacuation of the
owels from an enema. Pulse 100, of good strength; skin
warm ; restless and uneasy, but thinks the pain is not quite so
severe." The use of calomel and opium was continued, and
twenty-four leeches wqre ordered to the affected part, and
fomentations to be kept up. " Leeches acted freely, but without
affording relief.*' Next day there was some increase of the
tumour, which was still well defined, though some distention of
the abdomen had arisen. '' Pulse, 112 ; tongue clean and moist ;
no vomiting ; some scanty evacuation from mjection." Twelve
leeches and the continuation of the fomentations, together with
the calomel and opium, were ordered. The next day the tumour
was still further enlarged, and, notwithstanding an increased
distention of the abdomen, could still be distinctly traced out.
From this time the patient gradually got worse and worse.
The tumour appeared to increase, but its definition was lost in
the general distention of the abdomen, which progressively aug-
mented. The vomiting returned. The bowels became obstinately
obstructed, the pulse small and feeble, the tongue dry. The
skin became covered with profuse perspiration, hiccup came'
on, and she died on the eleventh day from the commencement of
the attack.
The signs of peritonitis in this case are by no means unequi-
vocal. The obstinacy of the constipation points perhaps to the
gut itself having become the seat of inflammation. It seems
certain that inflammation affects the coecum itself; yet how far
that disease is hable to be combined with inflammation of the
adjacent cellular tissue does not yet appear. The dissections
hitherto pubhshed hardly throw sufiftcient light on this point.
Albers, to whose memoir I have already referred, sa^s that
Puchelt* (to whom he ascribes the first notice of this cusease),
* I have not seen Puchelt^s memoir; Heidelb. Klinische Annalen, vol. viii.,
cah. 4 ; nor Posthuma's, De Intestini Cceci ejusque Processus Vermicularis Paiholo-
gia; Groning. 1836.
ON PERITYPHLITIS. 179
as well as Posthuma and other pathologists, have confounded
cases of perityphlitis with typhlitis or inflammation of the
ccecom itself. But though Albers has given a very elaborate
account of this disease, I have drawn little from him, and am
less disposed to rely implicitly on his diagnostics, because the
cases on which he founds are plainly less simple in their original
character and course than those described by the French patho-
logists before cited. It is nubiifest that one of the greatest
ol^tacles to the progress of pathology is the complication of the
cases which most usually prove fatid, of the dissection of which
almost exclusively minute accounts are obtained. For it is sel-
dom in our power to unravel a series of morbid alterations, when
any part of it is still unreduced to a general law, or to deter-
mine what changes existed before the last attack came on, —
what are the immediate results of that attack, — what are strictly
coincident compUcations ; — and of these, what are casual or for-
tuitous, — what are consecutive, or arise connectively with the
general tendency of the original disease. That Dr Duncan's
case was a complicated case, it seems impossible to doubt ; but on
the nature of the complication it is less easy to pronounce, or
whether the serious compUcations preceded the attack of peri-
typhlitis or followed it; and whether fortuitously or connec-
tively^ in the absence of a dissection, it is impossible even to
oomectore on probable grounds.
On the views of Albers, this case should perhaps be pro-
nomiced a normal case of perityphUtis, for it does not in any
respect agree with the character which he lays down as that of
typhlitis, while it does correspond in a great measure with the
cases which he gives as illustrating the coui;pe of perityphlitis.
And he plainly represents the disease as more apt to involve the
peritoneum, and more disposed to terminate fatally, even when
the pus has passed off by the rectum, than the French patholo-
gists, on whose cases I have mainly relied in the foregoing
account of perityphlitis.
There are but two cases reported in the memoir of Albers,
and as both somewhat resemble the two cases just given,
this is the proper place to refer to them. One of these is the
case of a cluld eight years of age, in whom this disease termi-
nated a highly acute attack, marked by alternate constipation
and diarrhoea. In the history of the case nothing is said of the
motion of the thigh being affected ; yet after death tiie psoas was
found red and softened, there was abundant suppuration adja-
cent to the coecum, but no perforation of its coats ; the peritoni-
tis was confined to one patch close to the coecum ; the mucous
membrane, however, of the coecum was red and easily detached.*
The other case is that of a butler, twenty-nine years of age,
• Albers, p. 1«2.
i
180 QN PERITYPHLITIS.
who had been m good health till the period of the influenza in
1835, when he began to suflfer from periodical pains of the
abdomen, and constipation. He was adyised to try the effect of
cupping and of a cold bath, after which the pain became dimi-
nished in intensity, but more constant, and concentrated in the
right iliac region, while diarrhcea alternated with constipation.
This state of things continued five days, during which he waa
engaged in his usual avocations. Then he became affected with
alternate chills and heat, and the pain in the right iliac region
grew very severe, and there were occasional colic pains. A
swelling now arose in the right iliac region, and soon after blood
and pus appeared in the stools. Death took place on the third
day after the aggravation of his complaints. On dissection, pus
was found behind the coecum, extending upwards to the kidney,
and downwards to the brim of the pelvis. There was an open-
ing in the coBcum the size of a small coin, and the pus was still
trickUng into the gut. The appendix vermiformis was hard and
thick, the right kidney was red and softened. The iliacus in-
ternus was indurated, and its cellular tissue was destroyed by
the pus. Both these cases are plainly far from simple.
The cases hitherto referred to illustrate the several less
favourable terminations of this disease, namely, suppuration
with discharge of pus by stool, the same with discharge by an
external aperture, and suppuration with superadded peritonitis,
or some other serious complication. The case which 1 am going
to report shows the most frequent course of the disease, when
it is uncomplicated, and proper treatment is early resorted to.
This case, of the particulars of which an abstract will suffice,
well illustrates the insidious mode in which this iilflammation
makes its attack.
The patient was a medical man about forty years of age.
Towards the end of July 1840, being to all appearance in per-
fect health at the time, he awoke in the middle of the night
with severe griping pain, which continued for two or th^ee
hours, and then passed off with a slight evacuation of the
bowels. He remained in bed for a part of the day without
uneasiness, and on getting up towards the afternoon felt nothing
but a sense of weariness, and of weight and slight tenderness
over the abdomen, as if the bowels were not sufficiently sup-
ported by the parietes. No new symptom arose for the next
two days ; he took a moderate quantity of light food, and slept
at nights as usual. He believed he was recovering his usual
health and strength under rest and restricted diet. On the
evening of the third day, when getting into bed, he noticed a
sUght pain in the fore-part of Sie right thigh, which in the
course of the night he found to commence in the right iliac
region. Next morning^ there was considerable pain and tender-
ness on pressure in that region ; and on exammation a distinct
J
ON PERITYPHLITIS. 181
hard circumscribed swelling, giving a dull sound on percussion,
and tender to the touch, was discovered there. The bowels
were free ; the constitutional symptoms were not well marked,
but the pulse was rather frequent, and unnaturally harsh and
jarriuff. Twenty leeches were applied to the swelling with
partial relief, and in the afternoon blood was drawn from the
arm to sixteen ounces. At night, a pill of calomel and opium.
Next day the symptoms had abated, but were not removed.
Venesection was again practised to the same extent, and twenty
leeches applied to the swelling ; the pill was continued. Ne^t
day the (usease seemed effectually got under ; two days after,
twenty leeches, on account of some stinging pains in the part,
were again applied, with complete relief. There was no longer
pain or tenderness in the part, but a slight hardness could
still be felt on careful examination, which entirely disappeared
after a trivial inunction with mercurial ointment kept up for a
few days. The state of the bowels gave no trouble after the
first morning ; and ten days after the commencement of the
attack, the patient waBted out quite well. Once or twice in
the course of the following winter some threatening of a return
occurred, which disappeared under rest and light diet ; and
since that time he has enjoyed uninterrupted* good health.
Drs Henderson and Skae concurred in the treatment of this
case. Dr Alison also saw the patient, but not till the character-
istic marks of the disease had almost disappeared.
The pathological seat of the affection which we have been
considering seems beyond doubt to be in the cellular tissue
between the fascia of the iliacus intemus and the coats of the
coecum. And this peculiar seat explains why the pus, when
produced, so unifonnly passes into the coecum itself. The iliac
fascia, though somewhat variable in character, is for the most
part a strong fibrous membrane. Its extent and connexions
form, so long as it is free from disease, an impenetrable barrier
to the progress of pus outwards. And when we remember
that about one-third part of the circumference of the coecum is
uncovered by peritoneum, and that the uncovered part is in
contact with loose cellular tissue interposed between the iliac
fascia and itself, we shall no longer feel any difficulties in un-
derstanding the chief peculiarities of pericoecal inflammation.
The pus is confined on every side by the close adherence of
the peritoneum to tlie cavity which it fines. The alternative is,
on the one hand, that pus so confined, almost in a sac, should
penetrate through the posterior wall of the coecum, which is
but making its way through a thin partition to a mucous open
cavity, or, on the other, that it should penetrate through the
substance of the iliac fascia, or ascend into the right meso-colon
bjr separating its lamime, or, detaching the peritoneum from the
ihac fascia, where it adheres close to it, should make its way
182 WATER-BRASH.
into the pelvis. Cases may be instanced, I think, in which
each of the consequences under the latter alternative has occurred,
yet very rarely by comparison, and not probably till the in-
flammation unchecked had extended beyond its original seat and
destroyed the substance of the fascia, or weakened the cohesion
between the laminsB of the meso-colon, or that between the
peritoneum and the subjacent substance, so that less resistance
was offered to its progress between the laminae of the meso-
colon, and beneath the peritoneum in €very direction, than
through the coats of the coecum.
Edikbuboh, 23 Nelson Street, 12/A June 1844.
On ike Occurrence of Sarcina Ventriculi ahng with Acetic^ Lactic^ and Car-
bonic Adds in Water-Brash, By Geoboe Wilson, M. D., Lecturer on
Chemistry, Edinburgh.
The object of the following communication is to direct the attention of
pathologists to some curious phenomena accompanying certain forms of
> morbid digestion in the human subject. Of these, the most remarkable is
the appearance of a microscopic cryptogamic plant (^Sarcina Ventriculi),
and of acetic, lactic, and carbonic acids, in a liquid ejected from the
stomach.
The first case in which these were found occurred to Mr Goodsir, and
was published by him in the Edlnbuigh Medical and Surgical Journal for
April 1842.* Since that period a case has occurred in the practice of Mr
Benjamin Bell of Edinburgh, who allowed Mr Goodsir and myself to
examine the matter ejected by his patient, in which the same organism
and acids were detected ; and Mr Busk of the Dreadnought hospital ship,
Greenwich, has published the history of three cases, where the sarcina pre-
sented itself, but no analysis was made of the fluids in which it appeared.
Five cases of the sarcina haying thus offered themselves in so short an
interval, and without any particular search being made for it, it cannot be
doubted that the development of this organism will be found no uncom-
mon accompaniment of certain derangements of the digestive functions.
With a view to direct the attention of medical men to the subject, I have
drawn up the following account of the more important particulars of the
cases already met with, along with some observations on the manner in
which the chemical and microscopical phenomena are related to each other,
and to the state of the system which attends their manifestation. I am
indebted to Mr Groodsir for much information on the subject, and for many
of the suggestions which appear in the following paper.
The first case occurred in the person of a gentleman aged nineteen, who
had been suffering for four months from what he believed to be water-
brash. He stated, ^^that it attacked him on awakening in the morning
with a feeling of distention of the stomach ; that without any effort of
• History of a Case in which a Fluid periodically ejected from the Stomach
contained Vegetable Organisms of an undescribed form, by John Goodsir ; with a
Chemical Analysis of the Fluid, by George Wilson, M. D.
WATER-BRASH. 183
vomiting, a quantity of fluid, varying in volume from two- thirds to a
whole washhand basinful, passed up from his stomach ; that after this he
was quite relieved, and experienced no further inconvenience till the
evening of the same day, when, without decided distention, sounds as of a
fluid boiling or bubbling, and proceeding from the region of his stomach,
were perceptible to himself, and to those around him ; that he slept well
enough, but was generally attacked next morning." The fluid ejected by
this patient " smelt like fermenting worts, with a &int acid odour. It
appeared, after having stood for a few hours, moderately transparent, and
of a light brown colour. It deposited in the bottom of the basin a quantity
of a ropy matter of a granular appearance ; and on the surface was a mass
of froth like the head of a pot of porter."
On examining the fluid with the microscope, the sarcina was at once
detected, and was found to present the following characters.* In every
instance the oi^ganisms presented themselves in the form of square or
slightly oblong transparent plates, of a pale yellow or brown colour, and
varying in size from the 800th to the 1000th of an inch. They were made
up of cells, the walls of which appeared rigid, and could be perceived passing
from one flat surfiice to another as dissepiments. These dissepiments, as
well as the transparent spaces, were from compression of contiguity recti-
linear, and all the angles right angles ; but the bounding cells bulged
somewhat irregularly on the edges of the organism by reason of the
freedom from pressure. These circumstances gave the whole oi^nism the
appearance of a woolpack, or of a soft bundle bound with cord, crossing it
four times at right angles, and at equal distances. From these very striking
peculiarities of form, Mr Goodsir has proposed for it the generic name of
SABCmA.t
On examining the ejected fluid, it was found to possess the following
characters. It was thick and viscid ; on standing, it deposited a large
quantity of ropy matter mixed with portions of undigested food, and when
filtered through paper, had a pale brownish yellow colour, and was quite
transparent. It still contained much am'mal matter in solution, becoming
opaque and flocculent when boiled, and giving a very copious precipitate
with infusion of galls. It also precipitated nitrate of silver densely, and
when evaporated to dryness, and exposed to a full red heat in a platina
crucible, left an ash containing much chloride of sodium. It reddened
litmus powerfully, and efiervesced sharply with alkaline carbonates. It
contmued strongly acid after being twice distilled, and did not precipitate
nitrate of silver, but retained the sour smell, which could now be recognised
as identical with that of vinegar. On . neutralizing the twice distilled fluid
with lime>water, and evaporating to dryness, a salt was obtained, which, on
^vug decomposed in a tube-retort with sulphuric acid, yielded a volatile
odorous add, readily identified by several tests with the acetic.
It was found by several trials, that on an average, an ounce of the liquid
neutralized 04 gr. of carbonate of potass ; a quart (32 oz.) would therefore
neutralize 12-8 gr., which correspond to 9 gr. of the hydrated (crystallizable)
acetic add, HO-f-C*H'0'. The liquid remaining in the retort con-
tinued to redden litmus powerfully, after all the acetic acid had been dis-
• The reader is referred to the Edmburgh Medical and Surgical Journal for
April 1842 for a more minute description of the sardna, and a detailed account of
the chemical analysis of the liquid containing it.
t Sardna J a pack or woolpack. The only spedes is named Sarcina VentricitU,
184 WATER-BRASH.
tilled from it. This was traced in part to the presence of a small quantity
of free muriatic acid ; but it was cliiefly owing to the existence in the liquid
of a considemble proportion of lactic acid.
The most remarkable feature of this case, in a chemical point of view, was
the largo quantity of acetic acid found. Although we have no account of
the proportion of tliis acid discovered in the healthy gastric juice, or chyme,
by those who maintain its presence there, it is certain tliat the quantity must
be very small. Prout overlooked the presence of an oi'ganic acid alto^ther,
and Gmelin, the great advocate of its existenco, found only traces of it. But
the quantity of liquid ejected at once by the patient often amounted to more
tlian two quarts, which would contain 18 grains of acetic acid. The liquid
otherwise was not particularly examined as to salts or animal matter.
Mr Bell's patient was a girl aged thirteen, who had suffered at intervals
for several years from derangement of the digestive oigans. At the period
when her case came before us, she was stated by Mr Bell to be '* subject
after her meals, particularly dinner, to enormous distention of the abdomen,
accompanied by a guigling noise and fetid eructations.''
From this state she was relieved by vomiting ; the matter ejected con-
sisting *^ of a thinnish moderately transparent fluid, with a thicker and more
tenacious portion like gruel at the bottom of the vessel. It was sometimes
covered on the surface by a mass of frothy matter, and generally there were
substances floating in it like undigested articles of food."
In this ejected matter Mr Groodsir found the sarcina in great abnndance,
and not distinguishable in appearance from the individuals obtained from
his own patient.
Only one specimen of the liquid from Mr Bell's patient was procured for
chemical examination ; and circumstances over which I had no control
prevented this being so complete as could have been wished. In general
appearance it resembled the liquid ejected by Mr Goodsir's patient, but it
had a paler colour, was less viscid, and less frothy. It reddened litmus
powerfully, and precipitated nitrate of silver ; a property it owed to the
presence of chlorides, for no free hydrochloric acid could be detected. A
portion filtered and evaporated on the water-bath continued to redden
litmus after prolonged exposure to a temperature of 212°, owing to the
presence of an acid, believed, for reasotfi stated in the previous paper, to be
the lactic. Another portion, subjected to a double distillation, yielded a
colourless liquid, which was not troubled by nitrate of silver, biit was found,
when examined by the method formerly described, to contain free acetic
acid. In chemicad characters, therefore, it corresponded to the liquid from .
the first patient.
An additional point, however, was ascertained, and that of some import-
ance. When the liquid from the first case was imder examination, its
frothy appearance fully satisfied me that it contained a gas in solution,
which was likely from other circumstinces to be carbonic acid. Experi-
ments accordingly were made, by warming the liquid in a flask fumkhed
with a bent tube dipping into lime-water ; and the latter was found to be
copiously precipitated. But no mention was made of these trials in the
former paper, because the method followed was objectionable ; since, though
carbonic acid was manifestly evolved in large quantity, it was quite possible
that it had resulted from the action of heat on a complex solution of organic
product?, and had not pre-existed ready formed. With the liquid, how-
ever, from Mr Bell's case, I ascertained the presence of a dissolved gas, by
a method which seems in itself unexceptionable. Chemists have long been
WATER-BRASH. 185
aware of the fact, that one gas passed through a solution of another, will
displace it> whatever their comparative solubilities he ; so that hydrogen or
nitrogen, for example, will liberate carbonic acid, and dissolve in its place.
Magnns has made a beautifal application of this law to the detection of
carbonic acid in blood, and I followed his method in seeking for the same
sabstance in the stomach liquid. A series of Wolfe's bottles was arranged
80 that hydrogen gas evolved from the usual matenale in the first should
pass in the second through a strong solution of caustic potass, to free it firom
any carbonic acid it might contain ; in the third, through lime-water, to
certify its freedom fivm this gas ; in the fourth, through the stomach-liquid,
to dii^lace whatever gas it contained ; and in the fifth, through lime-water
a second time, to show if the displaced gas were carbonic acid or contained it.
On making tiie experiment, it was found that the current of gas which
passed through the first lime-water without troubling it, on reaching the
aecond, threw down an abundant precipitate of caihonate of lime.*
This experiment proves unequivocally the presence of frree carbonic acid
in the liquid ejected by the second patient ; and I feel certain that the car-
bonic add was generated in the stomach, for the liquid was fitythy at the
moment of its disduuge ; and Mr Bell speaks of the distention of tiie belly
as ^accompanied by a guigling noise and fetid eructations^" which doubt-
lesB proceeded, from the evolution of this and other gases.
I have no hesitation in extending these conclusions to the first case ; for
the liquid from Mr Goodsir^s patient was more frothy than that from Mr
Bell's, and it gave off carbonic acid when dightly raised in temperature.
The patient also, in his account of his sensations, mentioned that ** sounds
as of a fluid boiling or bubbling, and proceeding from the region of his
stomadh, were perceptible to himself and to those around him." It is quite
possible that small quantities of other gases (carbureted or sulphureted
hydrogen) may have accompanied the carbonic acid ; but it was impossible
in the circumstances to ascertain this point.
The liquids^ then, from both these patients, contained, besides undigested
food and unexamined salts and animal matter, much acetic, lactic, and car-
bonic add, and in one of the cases a small quantity of muriatic acid. A
little carbonic add has been found along with other gases in the stomachs
of criminals executed soon after taking food ;f so that this gas may be in-
cluded among the products of normal d^i;e8tk>n. But the quantity found
has always been small ; and in the few cases where it has been possible to
* The gases contained In a mineral water may be separated by simply heating it,
and TeoeiTing them over mercury^ But this method can seldom be applied to or-
ganic liqnids, from the decomposing action of heat on their constituents ; and the
air-pump has generally been employed to. extract the elastic fluids dissolved in them.
The conflicting nature, however, of the statements concerning the presence of car-
bonie add in venoua blood, before the publication of the researches of Magnus, ahowa
the uncertainty attending the employment of this instrument, when the liquid under
cia mtn a f ion is visdd, and the quantity of gaa in solution is not very great. Magnus
states (FoggendorTs Annalen, bd. 40, § 683, quoted in Wagner*a Physiology, p.
377}} that " under the air-pump the gases of the blood do not begin to escape until
the column of mercury has sunk under an inch in height,** so that only instrumenta
of good construction can be employed for experiments of this kind. The method
by displacement, on the other hand, requires neither an expensive nor a very delicate
apparatus, and may often aflbrd valuable information concerning the gaaea in the secret
tioDs and circulating fluida of plants and animals.
t Liebig*8 Animal Chemistry.
2a
186 WATER-BRASH.
watch the progress of digestion ifk Hying animals, no disengagement of gas
has been ohserved,* nor is chyme at all frothy ; and in artificial digestion,
whether performed with gastric juice from a living animal, or with an
acidulated infusion of pepsine, no evolution of gas has been seen ;t so that
it is quite oertain that tlie carbonic acid which accompanied the sarcina m
these cases was in quantity abnormal.
The same remark applies to the acetic and lactic acids. The names of
various chemists were quoted in the published account of the first case, as
representing them as normal constituents of the gastric juice or chyme.
Their presence in these fluids is denied on the other hand by some of onr
latest observers^ and many will hesitate to decide on this question, till a
series of extended researches leave no doubt on the subject. I feel it un-
necessary, however, to urge a dedsion on a point which will be decisively
settled in a short period by the inquiries at present in progress. In the
mean while, all will acknowledge that these acids were abnormal in quan-
tUy^ and Uiis admission will suffice for our present purpose.
The first case in which the sarcina was detected by Mr Busk, was that of
a young man who had sustained rupture of the diaphragm. He had pre-
viously been in robust health, and survived the injury eight days, during
which he rejected every thing he swallowed. Besides the ingeista, he
vomited " a very laige quantity of a peculiar looking brown fluid,
amounting in the coarse of twenty-four hours to several pints.*' In this
fluid the sarcina was found.
The second case was that of a young man, previously in robust health,
who had sustained fracture of the spine and other injuries. ** About twelve
hours after the occurrence of the injury he vomited once, and once only,
«nd the matters rejected conasted of a small quantity of brownish fluid
mixed with food. The brown colour, as in the former case, was found to
depend upon the pres^ice of coloured flakes, composed for the greater part
of the so-called sarcina."
** The third case was that of a boy, aged about fifteen, who was afi^ed
with disease of the hip-joint, under whkh he had long laboured, and by
which he had been much reduced. A short time before his death he was
jseized witli acute pleurisy, which was attended with frequent vomiting ;
and in the matter thus rejected, and consisting of little more than mucus,
were observed many brownish flakes, which were found to be composed
principally of the sarcina." j:
In none of these cases was any analysis made as to the chemical character
of the ejected matter, so that the following remarks must be considered in
the mean while as applying solely to the first two cases.
Before attempting any explanation of the nature of this curious disease,
and the connexion between the chemical phenomena and the development
of the sarcina, it is necessary to notice that the ejected liquid must have
consisted partly of secretions from the stomach, partly of products of diges-
tion, ♦. e, of altered food. It is impossible to state accurately how much
waa contributed from each of these sources ; but, speaking generally, we
may say that the bulk of the liquid was secreted by the stomach, while
the acids were derived from the food, and the animal matter was supplied
by both.
• Beaumont^s Experiments and Observations on Gastric Juice.
t MUller and Schwann in M filler's Physiology, p. 692.
X For a particular description of these cases, and Mr Busk's views concerning
tlie sarcina, see Microscopical Jpumal for 1842, p. 321.
WATER-BRASH. 187
In the particular account of the tot case, reference was made to the
similarity between the ejected matter and a fermenting liquid. It was
impossible indeed not to be struck with its resemblance, not only in general
characters, but even in specific products, to a vegetable juice undergoing tlie
lactic fermentation,, in which carbonic acid and other gases are produced
along with lactic acid and a viscous gummy substance. The sarcina, too,
might be considered aa the analogue of the microscopic plants which are
found to accompany the fermentation of infusion of malt and the juices df
different fruits. For these reasons, and for others which aiv stated more
fully in the succeeding pages, I was led from the first, along with Mr
Goodsir, to regard this disease as resulting in great part from the food nof
dergoing withLi the stomach a peculiar fermentation ; and on a particular
consideration it appeared that three different views might be entertained
concerning it.
1. The disease might be regarded as depending on a simple or spontaneous
fennentation of the food, t. e. a fermentation resulting fr^rn one of its ooa>-
fitituents acting as a ferment to certain of the others^ and converting them
into the acids described.
2. The sarcina might be considered as the cawa morbi, and true ejusitani
of the chemical changes in the food, according to the views of fermentation
entertained by certain continental (^wervers.
8. The stomach might be looked upon as secreting or furnishing the
ferment, and the sarcina as an accompaniment only of the fermentation
excited.
The last view appears in all respects the most probable ; a f«w words will
suffice regarding the first two.
Several affections of the stomach might be referred to, aa fiivouring the
opinion that a spontaneous fermentation of the food had ocecured in this
disease. '* It is well known," observes Xaebig, '* that in many graminivor-
ous animals, when the digestive organs have been overioaded with £resh
juicy vegetables, these substances undergo in the stomach the same decom-
position as they would at the same temperature out of the body. They
pass into fermentation and putrefaction, whereby so great a quantity of
carbonic acid gaa and of inflammable air is gener^ed, that these organs are
enormously distended, sometimes even to bursting." Affections of this kind
are most common in ruminating quadrupeds^ and occur in them in the fiirst
and second stomachs, before true digestion has begun. They are on this
account not strictly comparable witib demngements oi digestion occurring
in the single stomach of a non-ruminant animal. But in the human sub.
ject analogous cases occur» resulting from the drinking of half-fermented
wines. The author already quoted refers to *^ the &tal accidents which so
frequently occur in wl^oie countries from the drinking of what is called
%ther-white wine This poisonous wine is wine still in a
state of fermentation, which is inoreaaed by the heat of the stomachy" and
the amount of carbonic acid is so great as to cause asphyxia by reaching
thelungs^
These cases certainly i^ow that the stomach has not the power of invari-
ably arresting the fermentation of substances introduced into, it ; nor even
of preventing its development, where the food is prone to suffer this change.
Nor does it seem improbable that some cases of morbid digestion may depend
on an inaction or atony of the stomach, permitting the food to decompose or
ferment spontaneously. But such a view is inapplicable to the cases before
us, for the stomach was not passive, but morbidly active, as the quantity of
188 WATER-BRASH.
liquid it secreted showed ; and the rapidity with which the food (consisfci '■ng
of bread, potatoes, and meat) was converted into the seyeial adds, ^^9i^^.as
much too great to be explicable on the supposition of spontaneous fermeKirfc.^^
tion« For these reasons it seems necessary to seek for a ferment out of -^^ne
food. The other hypotheses are framed to meet this necessity, and may^ 'Km
contended for on quite independent grounds.
The second hypothesis, which represents the sarcina as occasioning -ft^'Siie
fermentation, is at least interesting in relation to these cases, since it was -^lie
anticipation of some organism being present which led to its discoY^sc-;^.
Schwann and Cagnard Latour first showed that the fermentation of infusi.<:»:x»
of malt by yeast, and the spontaneous fermentation of grape-juice and ap;E>l^
juice into idcohol and carbonic acid, are attended by the development of s
microscopic cryptogamic plant, to which the name of Scuxskaromycea or Bxm.^3C^^
fungus has been given. And some physiologists have represented th»-^^«»
fungi as the true cause of such fermentations, — as nourished, in short, ^^y
the sugar which they excrete as alcohol and carbonic acid.*"
But before such a conclusion was drawn, it should have been shown tl=»-**
sugar cannot be fermented into alcohol and carbonic acid without the d^"*^*"
lopment of these fungi, which has not been done. It seems certain enoi:^.^^
that the vinous fermentation of malt and of fruit juices is always aocc^^*^"
panied by the appearance of the saccharomyces. But these liquids confc-^^"^^^
azotised matter besides sugar, and it has not been shown that the fungi a^^^*^
more closely related to the latter than to the former. The well-known 03^»>^
that the whole sugar is converted into alcohol and carbonic acid, while -tf^ Vie
frmgi increase in size and numbers, seems enough to show that they m. "■^*^
derive their nourishment from the non-saccharine constituents of the liqiB-^^- ^
in which they appear. Before the opposite conclusion is drawxi^ it sho w ^* -^^
be shown that when a solution of pure grape or milk-sugar has the ^ '
fermentation induced in it by the addition of decomposing animal mati^-*
these frmgi appear, which hitherto has not been done. There is still ro<^ -
therefore, for doubting if the saccharomyces are so much as constant <
comitants of the fermentation of pure sugar. And even if it could be sho^^^jj**
that the appearance of these fungi during fermentation was invariable, -^ *
would renudn highly improbable that they were more than concomitan*^-*
For the chemist can refer to many decompositions identical in nature wii>^^
fermentation, where no organism of any kind appears ; and the chemicsa^
forces which suffice alone to effect great changes cannot be supposed to \q3&
their efficacy because cryptogamic plants are developed, so that we should
conceive them to be supplanted by certain inexplicable and improbable
powers supposed to reside in these organisms. For these reasons, and for
others which I need not detail, I discard this hypothesis as untenable, and
refrise to the sarcina the offi^^e of decomposing the food in an abnormal way.
The third hypothesis represents the stomach as supplying the ferment or
substance which decomposes the food into the acids found.
To make my views on this subject clear, I must premise a few obsenra-
tions on the nature of healthy digestion. According to all recent re^
searches, the performance 6f this frmction is dependent on the presence in
the stomach of two difft^rent substances, — the one, frree muriatic acid, the
other, an animal matter, to which the name ofpepHne has been given. An
* For fuller information on this subject, see Meyen's Report on the Progress of
Vegetable Physiology for 1839, p. 37. Lehmann Taschcnbuch der Chemie (1842),
p. 979. Liebig*s Chemistry applied to Agriculture, p. 380. Annalen der Phar«
xnacie, band 29, s. 93 and 100.
' WATER-BRASH. 189
infiisioD of this pepsine has no solvent action on hard albumen or other
alimentaiy matters ; but its addition, even in minute quantity, confers this
property on water acidulated vrith muriatie acid.- The interest thus turns
on the way in which the pepsine acts in conferring this power on the aci-
dulated water ; and on this point chemists are at^issue. There are different
shades of opinion, but, speaking generally, the theorists may be divided
into two classes : 1st, Those who, along with Berzelius, represent the pep-
sine as acting cataiyHcailpf i, e. as determining the solution of the food by
its mere contact with it, without taking from it or adding to it, or itself
undergoing any change ; and, 2dy Those who agree with Liebig in repre-
senting the pepsine as an efficient cause of alteration in the food, solely
because its own paiticles are in a state of decomposition or transformation.
Liebig does not use the term ** pepsine," but I employ it, in explaining
his views, for the sake of convenience. His own words are, " The clear
gastric juice contains a substance in a state of transformation, by the con-
tact of which with those constituents of the food which by themselves are
insoluble in water, the latter acquire, in virtue of a new grouping of their
atoms^ the property of dissolving in that fluid." Pepsine is thus repre-
sented as bearing the same relation to the food whose digestion it effects,
that yeast does to the sugar which it ferments ; the difference being, that
in digesticm the elements of the food assume a new arrangement, without
separating into two or more groups, whereas in the vinous fermentation
{ex,gr,) those of the sugar are broken up into alcohol and carbonic acid.
Without entering into any discussion of these opposite views of diges-
tion, I adopt that of Liebig as the more probable and tuigible of the two, and
apply it to the eases before us in the following way :
The transforming action which pepsine exerts on the food is limited in
the normal state to rendering its insoluble portions soluble in the gastric
juice. But all the azotised bodies, such as diastase, yeast, albumen,
casdne, which play the part o( ferments, and among which pepsine
b ranked, pass through several stipes of decomposition whilst performing
this function, and modify the non-azotised bodies (such as sugar) on which
they act, in a different way, according to the state of decomposition in
which they are. Thus, when fresh milk is exposed in open vessels,
its caseine becomes altered l^ the action of the air, and ferments the sugar
of milk which accompanies it ; the latter being transformed into alcohol
and carbonic acid, into lactic acid, or into a mixture of these, according to
the stc^ of decomposition which the caseine has reached. In the same
way a piece of fresh bladder, which at first has no action on a solution of
sugar, after exposure to the air, acquires the power, according to its state of
decomposition, of resolving it into lactic acid, into mannite and mucilage,
or into alcohol and carbonic acid.*
From these considerations it appears, that, within certain limits, if the
mode of decomposition of the foment alteis, the mode of decomposition of
the fermented body must alter also. The constant resolution of sugar into
alcohol and carbonic acid, which constitutes the vinous fermentation, is the
result or reflection of an equally c<mstant though'quite different decompo-
sition in the ferment which occasions it. When the latter decomposes in
another way, the former reflects the change by decomposing in a new way
also, and the lactic fermentation {ex, gr,) replaces the vinous.
In the same way, if normal digestion, t. e. the resolution of the food into
• See a paper by Boutron and Freniy, in the Annalea de Ch. et de Ph., tome xii.
190 WATBR-BRASH.
certain soluble compounds^ be the vesult of a eonstant decompofiition of the
pepsine in one way, it must be liable to be rendered abnormaly and the food
to be resolved into quite different products, by the pepsine decomposing in
a different way. I look upon the cases before us as presenting derange-
ments of digestion of this kind. All the chemical phenomena they ex-
hibited led me to look upon the stomach as the seat of a fermentation ; but
whilst seeking for a ferment to account for this, I have been saved tbe
necessity of assuming any absolutely new one by Lkbig's view, which repre-
sents normal digestion itself as a fermentatum, and pepsine as a ferment.
I suppose, accordingly, that the carbonic, acetic, and lactic acids found in
such abundance in the ejected liquid, were products of the fermentation (a
transformation of the food (probably of its non-aasotised or saccharine and
amylaceous portions) determined by its contact with the modified pepsine.
As caseine, by a slight alteration in its condition determined by the actimi
of the air, induces the lactic instead of the vinous fermentation in sugar, so
we may believe that pepaine, in virtue of a nmilar change, determined in
the same way, decomposes the food into these acids, instead of siinply
effecting its solution.
It is possible, perhaps, to carry our speculations £Eurther. In the second
case no free muriatic acid was found ; in the first, throughout the whole
course of the disease, it was detected only in very small quantity. A
diminution in the quantity of muriatic add secreted by the stomach, may
be the cause of the abnormal decomposition of the pepaine^ and the corres-
ponding abnormal decomposition of the food. I mention this here, not for
the sake of pursuing the speculation, but to direct the attention of those
who may meet with new cases of the aarcina and acid watei^brash, to the
question whether muriatic acid be present in the liquid or not, as an im-
portant datum for future conclusions.*
NOTICE.
A paper utas prepared by Professor Auson and intended for thU number. It
has been unfortunately mislaid^ but we hope to be able to insert it in our
next, — Editors.
Part II.— REVIEWS.
Lectures on the Theory and Practice of Midwifery. By Robert Lbb, M.D.,
F.R.S. 8yo, pp. 553. Longman, Brown, Green, and Longmans, 1844.
CoNsiDERixo the unwearied industry with which the sayings and doings of
Dr Robert Lee have been reported by the periodical press for years past,
and the extravagant plaudits which have been so unsparingly bestowed on
bis exertions, it may be deemed a bold step of infant journalists, such as we
•re, to undertake the analysis of his prelections. As these discourses, how-
ever, have now been twice revised,— ^r«l, for circulation in the London
Medical Gaaette, and seeandfyy for republication in the volume before us,
and, as this great master of the o bstetric art informs us, at the « desiie
* It woald be a favour to Mr Goodsdr mod myself if any inactitioiier nceting
with a case of acid water-brash would send a specimen of the ejected matter lor
examinaUon to mj Laboratory, 24 Brown Square, Edinbargb G. W.
THEORY AND PRACTICE OF MIDWIFERY. 191
sirongly espraned by many students and practitioners," it might be con«>
sidered a dereliction of duty were we not to state our opinions respecting
them.
Dr Lee is a man of ability ; but it is quite possible for a man of ability to
write an indifferent book on midwifery.
The introductory lecture is in the discursive rein. The lecturer has
followed the Horatian precept, **in mediaa reSy* with a witness. He tonches on
many points which the student cannot possibly understand, his object being
in the first instance to exhibit the manifold dangers to which women are
SQbjected in child-bearing and labour. The eyidence on this head is summed
up with a statistical view of the mortality among pregnant women, and
women during and after parturition in different countries and institutions.
He then turns to a history of midwifery in ancient times among the Israel-
iies and Greeks, and dwells on the attainments of Hippocrates in this
line. We are amused with his zeal in behalf of the obstetric knowledge
of Hippocrates, which it must be confessed was somewhat deficient, at
least in precision ; for though Hippocrates, it appears, anticipated Am-
brose Pare in the proposal to turn, yet his project of turning was in the
wrong direction. We do not indeed observe at first sight from Dr Lee's
aoGonnt any thing of which Hipprocates was ignorant that accoucheurs
know at present, except that he had no insight into the nerves of the uterus^
and that he failed to discover that an olive, lying across the inside of the
mouth of a jar, like a cross birth, had not the head, legs, or arms of a ma-
ture foetus.
After this follow a few well-assorted and instructive paragraphs, quoted
from Pare, regarding his proposal of turning, and bringing down the foetus
by the feet ; there are then a few brief remarks on the advancements and addi-
tions to obstetric science and art made by Guillemeau and Chamberlayne, after
them the names of Smellie and Mauriceau are but barely mentioned ; but
what has become of Rcederer, of the Steins, the Siebolds, the Osianders,
the Naegeles, and the long time-honoured list of our own countrymen !
The only other discovery which appears to Dr Lee at all to approximate
in importcmce to that of the version of the foetifs, is his own so-called dis-
covery of the uterine nerves. Even granting that Dr Lee's dissections display
nerves, which is very much doubted by many who have inspected them,
we think that matter of much greater utility and interest might have been
given in an introductory lecture than an anatomical detail of parts which
may turn out to be in a great measure fanciful. An excellent sentence
concludes the lecture, but it too is a quotation from Sir Joshua Reynolds.
We have now done with this discursive prologue, and proceed to examine
the character and value of the instruction afforded to the pupils of St
George's Hospital School. The description of the bones of the pelvis is
excessively meagre and incomplete ; it is in some places so loosely worded
as to lead to an erroneous idea of the parts, and in fact is but a bare anatomy
of knobs and holes. We would lay part of this before our readers to bear
out our statement, but other errors or omissions of greater importance claim
our notice.
The inclination, muscles^ and blood-vessels of the pelvis are thus briefly
discussed : — *^ The plane of the brim is inclined downward and forward so
as to form a great angle wiih the vertebral column" (p. 17) ; any thing be-
tween 90 and 180 degrees being quite inmiaterial to Dr Lee. " In the
living body the psqc muscles, with the iliac blood-vessels, extend along the
sides of the brim of the pelvis, and modify its form; " the modification of
192 THEORY AND PRACTICE OF MIDWIFERY.
the form of the brim does not appear to be worth mentiomog. We had
thought that all circumstances tending to modify the form of the pelvis,
however slightly, in part or in whole, were of the utmost importance in
practice. The characteristics of the male and female pelvis are despatched
in a line or two, as follows : — ^' The bones of the male pelvis are stronger and
thicker tlian in the female, the cavity is less capacious, and the pubic sich.
is smaller," p. 18. In fad, we believe the description of the pelvis as given
by Dr Lee to be the poorest and most meagre in print.
The next subject which Dr Lee considers is Disease of the Articulations
and Bones of the Pelvis. Of the deformities caused by these he gives three
varieties only — lst,That arising from arrestof development ; 2dly, Frommala-
costeon ; and, ddly. From rachitis ; the varieties arising from exostosis are
only named, and that described by Naegele das sdirdg eerengte Becken, or,
as translated, ** the obliquely contracted pelvis," is not once alluded to.
In speaking of the first variety, Dr Lee says, ** In some women the pelvis is
not developed in the usual manner, cmd it remains small through life, al-
though not distorted. Its condition is very different from what it is in
childhood." The doctor appears to be unaware that there are two species
of this variety .: one of these he has described in a style which is confused,
and we are confident unintelligible^ to the mere student ; but the second,
where the pelvis remains precisely as it was in childhood, even to the carti-
laginous junctions of the bones composing the os innominatum, he has
entirely omitted.* The distinctive characters of the rachitic pelvis, and
that deformed from malacosteon, are so jumbled together, that we are unable
to extricate them from the maze of confusion. This, however, is sufficientiy
accounted for by the doctor stating afterwards, " that the chajiges produced
by rickets do not difiPer essentially from those observed in malacosteon.'*
Although this is a doctrine which is held by many, and although we see
pel vises, in the museums of those who should know better, indiscriminately
labelled " rachitis," or " malacosteon," as if a shower of labels had Mien on
them accidentally, we can by no means assent to the opinion ; and we cer-
tainly agree with the statement that " it is not the difierence in the disease
that gives rise to the deformities characteristic of the two afifections, but
that it is the difierence in the condition of the pelvis, at the periods at which
it suffers from them ;"t for it is in infancy that the pelvis is attacked by
rachitis, but it is after puberty that it suffers from m^costeon.
The third lecture treats of the " Anatomy of the XJnimpregnated Uterus
and its Appendages." It is not so full as we could wish, nor are the details
given with that pointedness and preciseness which are so necessary in de-
scriptive anatomy ; for example, the situation of the uterus is thus de-
scribed : — ** The uterus is situated within the pelvis, behind the bladder,
before the rectum, below the small intestines, and above the vagina ;" we
might almost as well have been told that the uterus is within the skin, above
the heels, and below the eyes. In this lecture, also, on the unimpregnated
uteruSy the doctor is rather excursive, for he branches away to the question
of the presence of a decidua in extra-uterine gestation, and as to whether
phlegmasia dolens depends on inflammation of the pelvic veins or not.
The fourth lecture, comprising the " Physiology of the Unimpregnated
Uterus and its Appendages," is good and interesting ; it contains much that
is valuable in the shape of statistics of menstruation, and several important
* Naegele das schrftg verengte Becken, s. 101.
f Campbeirs System of Midwifery, p. 674.
THEORY AND PRACTICE OP MIDWIFERY- 193
dissections in support of the theory that this secretion is canscd hy
hypersmia of the uterus, consequent upon the escape of Graafian vesicles
from, the OTary. We shall not fiitigue our readers with any discussion as
to the priority of claim to this theory ; for during the last month the pages
of our journals have teemed with letters on this suhject, from Dr Lee, his
partisans, and their opponents. This much we know, that certain anatomical
specimens, relating to this suhject, were shown hy Dr Girdwood to Dr Lee
previous to Dr L.'s puhlication of his views on the matter.
The next lecture contains a good description of the corpus luteum,
though rather too much of it is taken up with the question, as to whether
the yellow matter is developed hetween the tunics of the Graafian vesicle
or without the outer coat. Dr Lee here states, " that not unfrequently
two corpora lutea are present in the ovaria, where there is only one ovum
within the uterus." This taken to the letter is correct, hut is extremely
apt to lead to a false inference. If the doctor means that two corpora
lutea may he found where one ovulum only has been impregnated, we
must refose our assent to his belief ; for we have never seen or heard of
any unequivocal instance of such an occurrence, Dr Montgomery, though
he mentions one or two observations of this nature, details them in a
manner so hesitating, that we are inclined to believe he attaches no credit
to them ; and we think Bailer's statement " numerus corporum luteorum est
in ratione foBtuum*' is still uncontradicted. The lecturer continues : ** I
found a perfect corpus luteum in the ovary of a woman who died from in-
flammation of the uterus, soon after the expulsion of a mass of serous cysts, or
hydatids, as they are termed." We are happy to have this statement from
the doctor, in corroboration of the opinion that the so-called hydatids are
merely a dropsical degeneration of the tunics of the ovum, and that their
presence is an evidence of impregnation having been effected, — a feet which,
had it been ascertained at that time, would have been of much value on
the well-known trial of Mr Angus of Liverpool.
As in a work on midwifery, those portions which treat of practice are, or
ought to be, the most valuable and highly finished, we must be held ex-
cused if we treat with some brevity of the remaining lectures on the
anatomy and physiology of the uterus and ovum. Lectures 6th, 7th, and
8th, contain nothing sufficiently important to demand observation. The
9th lecture, though we cannot concur with all therein affirmed, is excellent,
and, with other valuable matter, contains an unanswerable contradiction to
the advocates of the ** double night-cap decidua." As the preparation
from which Dr Lee was enabled to demonstrate the incorrectness of their
position is probably unique, we shall extract the description. It was a
litems in the second month of pregnancy, having the placenta attached
chiefly over the cervix, taken from the body of a woman who had
poisoned herself.
"If," says Dr L., "you examine this gravid uterus of two months,
you will see the chorion and amnion enclosing the embryo and
umbilical cord, and the placenta covered with its decidua adhering
all round to the upper part of the neck of the uterus. You w^ill also
see clearly, that the decidua reflexa lies entirely above the villi of the
chorion, on that side of the ovum where the placenta does not exist, and
where the ovum is not attached to the uterus. In all the diagrams from
Dr Hunter, Wagner, and other anatomists which you have seen, the
placenta has invariably been represented as adhering to the fundus uteri,
and the decidua reflexa has been situated near the cervix, and appearing as
2b
li^4 THEORY AXU PRACTICE OF MIDWIFERY,
if mechanically depressed or pushed down befoie the ehorion or oyuio.
But in this preparation it is obvious that the decidua reflexa eould not
have been puslied down before the ovum, because it lies above or covers
the ovum,— the ovum lies between the decidua reflexa and the cervix
uteri, and as the oviun enlarged, the decidua reflexa must have been forced
upward to the fundus uteri, which was lined with the decidua rera, instead
of downward to the cervix. The decidual cavity is, you observe, at the
fundus uteri, above the ovum, and both Fallopian tubes open into this cavity
by palpable orifices. Instead of being covered with the uterine decidua,
this membrane passes into them, and they are left completely pervious, so
that no membrane existed which the ovum could mechanically push before
it." P. 80.
These facts show that the decidua does not form a shut sac in the early
months of pregnancy, but that the openings of the Fallopian tubes are
permanent, and that therefore there exists no membrane which the ovum
can push before it to form the decidua reflexa. The lecture concludes
with the doctor's views of the uses of the decidual cavity ; they appear to
us to rest on but very feeble grounds, and to be in much need of confirma-
tion from other observers.
The 10th lecture contains a tolerably good account of the growth of the
uterus, its nerves and vessels, during gestation ; the 11th is entirely the
doctor's own, embracing solely his nerves and ganglia. The 12th, 13th,
and 14th lectures, on the membranes of the ovum, cord, placenta, and foetal
peculiarities, are good ; the last, however, is rather meagre, as it attempts
to include too much. We are surprised to find in the 15th lecture the
signs of pregnancy handled with such brevity ; many that ought to have
been mentioned in a lecture are omitted, and the sign which in our estima>-
tion is second only to the sound of the foetal heart, viz., internal ballotte-
ment, is treated most superciliously. The doctw ofi&rms also, that ballottement
per vagiruim is better ascertained with the female lying in the usual labour
position than in the erect posture. Such a dictum we should expect from
one who had never attempted a vaginal examination in the erect position ;
for the idea is totally opposed to reason, to conmion sense, and to fiict.
The 16th lecture contains a series of cases of concealed, feigned, and com*
plicated pregnancy, possessing but little interest.
The 17ih and 18th lectures are devoted to the oonaderation of extra-
uterine gestation and abortion. The former of these subjects is miserably
defective, ibr all that the lecturer communicates regarding it is contained
in two pagea and a half. Dr Lee, whether from ignorance of its literature,
or that it would be derogating from his importance to consult contemporary
authorities, traces its history, not from the time of Albucaais of the 11^
oentmy, but from that of Riolanus of 1650. He takes no notice of the
excellent communication and ingenious views of Dezeimeria^ nor of the
elaborate memoir of Dr Campbell. Four lines contain all that is said of
the symptoms ; he is altogeUier silent r^;arding the diagnosis^ and tiiere
is not a word on the subject of causes. Our author is hostile to the attempt
of emancipating the foetus alive, without stating any reasons ; and as we
are equally opposed to this measure, we shsJl mention the has^ on which
our objections are founded. Gestation is a period, owing to the h^hly ex-
cited ^te of the noTous system, and the consequent &citity with which
genual disturbance is produced, that is most un&vouiable to soigicfll
operations. Hence, of nine women who were operated on while the fetus
WIS alive, or shortly after its life became extinct, not one survived ; while
THEORY AND PRACTICE OF MIDWIFERY* 195
of foHy on whom gasirotomy was performed, or the dilatation of an
ulcerated opening in the parietes of the abdomen was practised some time
sabsequent to the death of the foetus, thirty-six had so complete a recovery
that many of tk^n produced living children afterwards. The remainder of
this lecture and the whole of the next are devoted to the consideration of
the causes^ symptoms, and treatment of abortion ; and although there is
nothing novel in the discourse, the lecturer nevertheless appears to con-
siderable advantage, from the attention which he seems to have bestowed on
the pathology of the ovum.
Among the averments in this lecture, we cannot overlook the following
(p. 175), viz., " that abortion is ofUn one of the first symptoms of ma-
lignant disease of the uterus, and women who have in the walls of the
uterus a number of fibrous tumours embedded, never carry their children
till the full time." The word " often " would appear to hold an elevated rank
in the vocabulary of Dr Lee ; but it seems to us to be too frequently em-
ployed by him incorrectly, as in the foregoing passages, though we hope,
for charity's sake, without the usual signification. We positively deny
that abortion is often one of the first symptoms of malignant disease of the
uterus ; and in support of our assertion we need merely refer to Dr Lever's
veiy interesting statistics (Med. Chir. Trans., London, vol. xxii. p. 267),
wherein we are informed, that of 113 women who had carcinoma uteri,
forty per cent, only had miscarried ; and as for ourselves, in no instance
that fell under our observation, where there was malignant disease of the
uterus during gestation, did either abortion or premature labour happen.
And in regard to the second opinion advanced by Dr Lee, we regret to find
that he has profited so little by his pathological industry as to be unaware
that individuals with fibrous tumours embedded in the walls of the uterus
may advance in their gestation to the natural term. Several instances are
known to us where pregnancy was completed under these latter circum-
stances, but where the event was disastrous in consequence of uncontrollable
hemorrhage.
We concur with the lecturer in thinking that the expression ^ habit of
aborting," as fi^plied to females who have repeatedly experienced this acci-
dent) is insufficient to account for the cause, which, independently of some
morbid condition of the membranes, placenta, or fcetus, may often admit
of a very different explanation. As local or uterine debility and consequent
plethora are almost invariable results, even where miscarriage has only
once happened, it seems reasonable in many cases to ascribe the accident to
these conditions ; and the rather, since it is well known that frequently, by
temporarily suspending the procreative function, and thus affording an
opportunity for the tone of the reproductive system to be improved, the
disposition to abortion is removed.
Among the causes of abortion, syphilis and mercury are specified by our
author ; and he believes them boUi to act as specific poisons which destroy
the vitality of the foetus. The influence of the first of these must be
&miliar to men even of moderate practical information in midwifery,
though its modus operandi must be pure conjecture ; and in regard to the
latter, though, in cases where there is a predisposition to abortion, mercury
will occasion this accident with as much certainty as the former, yet the
hare idea of its acting as a specific poison is such a perversion of known
ftcts, that it is difficult to conceive how Dr Lee could have brought him-
self to advance so rash an opinion. We cannot for a moment suppose him
to be ignorant that mercury is frequently exhibited, during pregnancy, to
196 THEORY AND PRACTICE OF MIDWIFERY.
females who have often previously aborted owing to the foetus being con-
taminated by 83rphilis, and that instead of poisoning, it preserves the fcetua,
which is bom alive. We have known females illegitimately pregnant
unmercifully salivated with the criminal intention of procuring abortion,
but unsuccessfully, as the foetus was bom alive, and even appeared plump
and vigorous. And we have known pregnant women severely salivated by
mistake, upon the supposition of their having ovarian disease, but without
any detriment whatever to the foetus.
When the use of mercury is followed by abortion or premature labour,
the accident will admit of a very diilferent and quite as satisfactory an ex-
planation, — ^it must be ascribed to local excitement and consequent injury
to the utero-placental vessels. And, accordingly, Dr Lee himself informs
us, and we happen to be familiar with the fact, that when mercury is
exhibited to an undue extent during gestation, fatal hemorrhage may be
the result. Calomel we have known, where it was taken in an over-dose,
induce premature labour and fatal hemorrhage, by occaaoning severe irrita-
tion of the bowels, propagated to the uterus, and followed by excitation of
its fibres and premature detachment of the placenta.
Dr Lee terminates his enumeration of the causes of abortion by particu-
larizing knots on the funis, and the latter being firmly entwined round the
neck of the foetus. Of several foetuses, with knots on the umbilical cord,
which we have seen, all were bom alive except one, which had been
destroyed by syphilis. And we have yet to learn how the foetus before
birth can be destroyed by the cord being firmly drawn round its neck,
except by preventing the return of the blood from the brain, which is just
barely possible ; and, accordingly, we have never yet seen a dead foetus
produced under such circumstances.
The 19th lecture is occupied with observations on the transmission to the
foetus in utero of scarlatina, rubeola, variola, and syphilis ; and on dropsy
of the amnion. Of this last some very instructive cases are added in iUu»-
tration ; but in his diagnostic marks Dr Lee is very meagre. We are not
told that the foetus is reached per vaginam with difiiculty, and felt very
indistinctly ; that its movements are communicated but obscurely to the
parent ; that her abdomen enlarges with rapidity ; that her general health
may be unaffected until an advanced stage of pregnancy ; and that there
is then the most distressing dyspnoea.
The 20th lecture is an exceedingly rambling discourse. The teacher
begins with varices of the pelvic limbs, advances to the uteras, whence,
quite unexpectedly, he jumps to the head, and thereafter he wheels about
to the thorax. Though, to speak phrenologically, Dr Lee's work aflPords
evidence that some of his organs — ^for example that of Self.esteem — are
highly developed, yet hb region of Order must be a perfect blank. The
subjects comprehended in this lecture are sadly jumbled together, and do
not contain a single new idea. We pass on to the 2l8t lecture, which intro-
duces us to the important subject of parturition. The first thing by which
we are remarkably stmck here is Dr Lee's great talent for condensation.
Though we readily admit that comparisons are odious, yet we cannot help
contrasting the amount of matter furnished by Dr Lee on natural labour
with that which is contained in recent systematic works in our own lan-
guage on the same subject. In the work of Dr Eamsbotham, jun., and
some other systems published of late, we find at least three times as much
information on natural labour as in Dr Lee's lecture. We admit that it is
quite possible for one man to convey as much instruction in two lines as
THEORY AND PRACTICE OF MIDWIFERY. 197
another in six ; but, be this as it may, we have no hesitation in stating that
Dr Lee's lecture on natural labour is exceedingly meagre ; for if there be
any one divi^on of parturition on which a teacher ought to dilate more
than another, natural labour is that diyision, since the conduct of the prac-
titioner in every other variety of parturition must be guided by the rules
which ought to regulate his proceedings in the management of natural
labour.
Although we have some idea where Dr Lee acquired a part of his ele-
mentaiy obstetric education, we presume that he is entirely indebted to the
nice turn of his own mind for the following delicate precept — ^that the
practitioner, in proceeding to make an examination, is to advance ** the fore-
fing^ of the right hand to the anus, and along the perinceum to the vagirta**
If the lecturer's aim be originality, as £Eur as our knowledge goes he has
completely attained his object ; and we are very sure that no man posses-
sing delicacy of feeling will attempt to deprive him of, nor indeed envy him,
the merit of priority ; for of all the methods we have heard of, this is un-
questionably the most offensive. To those of our brethren who are
unacquainted with midwifery practice, it may seem of little moment, pro-
vided the parts be not exposed, in what manner the examination is con-
ducted ; but to those who devote their attention to this department of the
profession, it must be well known that indelicacy or maladroitness in the
performance of this duty is not unfrequently the cause of the practitioner's
dismissal. We shall not insult our readers by pointing out the method
which should be pursued, as this will readily suggest itself to every man of
The next passage in the same lecture, deserving the particular attention
of our readens, is one containing sentiments which we certainly never ex-
pected to find inculcated by any one pretending to a scientific and practical
knowledge of midwifery : —
" In no case is,it necessary or proper at the commencement of the labour,
before the membranes are ruptui-ed, and the first stage completed, to
endeavour to discover in what position the head of the child is placed
relatively to the pelvis of the mother ; it is enough to know with absolute
certainty that the head presents." — " Any attempt to determine in wliicli
of the numerous positions described by some authors the head is placed at
the brim of the pelvis, would only endanger the rupture of the membranes,
and disturb the regular order observed by nature in the process. I am
greatly at a loss to discover what benefit could result from knowing, during
Uie fi^t stage of labour, provided you can touch the vertex with the point
of the finger, in which of the six or eight positions of Bandelocque, and
other foreign authors, the head is placed." P. 223.
Although we are unwilling to believe that Dr Lee, notwithstanding
his love for originality, could have had any intention to mislead his pupils,
we do not, however, hesitate to maintain, that the foregoing precepts are
not only at variance with the experience of every practitioner of midwifery
gifted with the power of observation, but certain, if acted on, to be produc-
tive, in many instances, of a great amount of suffering to the patient. It
is so far necessary during the first stage, and if possible before the mem-
branes have been ruptured, to decide the position of the head, that unless
we have a correct knowledge of it, we iSiould give an erroneous opinion
regarding the manner in which the labour might terminate, its duration,
and the degree of suffering which the patient might be compelled to endure ;
on all of which points the parties concerned are not only most anxious to
108 THEORY AND PRACTICE OF MIDWIFERY.
know our opinion, but insist on being informed. Secondly, by discovering
in the early part of the first stage an unfavourable position of the head, the
practitioner, unless he confide in the mischievous principles inculcated by
Dr Lee, will watch the case, that, when uterine dilatation is sufficiently far
advanced, he may embrace an opportunity, before the menrbranes have
burst, of endeavouring to rectify the position of the head, should this be
necessary ; for, after it has considerably advanced through the brim in a
wrong position, and the liquor amnii has escaped, it will almost always be
difficult, and often impossible, to effect the required change.
We admit that there are certain positions of the head which -do not call
for interference ; but there are others in which frequently, if assistance
be not affi)rded, the patient is obliged to submit to severe and protnfbted
agony. Every practitioner of candour who has met with such cases will
acknowledge that when the vertex is placed behind the pubes, or in con-
tact with the sacrum, the progress, where the powers of the parent are
relied on, owing to the unsuitable position of the head, is yery slow, and
the sufferings of the patient much aggravated ; and every man of experi-
ence will also admit, that when the brow is towards either acetabulum, if
the face should descend into the pelvic arch, as occasionally happens, that
the transit of the head in far the greater number of instances is much
retarded, and the patient's uneasy feelings greatly increased.
From the 22d to the 26th lecture inclusive, we have the management of
cases of protraction and difficulty arising under the usual causes, such as
rigidity of the os uteri, of the membranes of the ovum, and of the external
parts ; tumours, hard or soft, within the pelvis ; premature ossification and
preternatural growth of the cranium, hydrocephalus, malposition of the
head, and shortness of the funis ; and, blended with his observations re-
garding these varieties of labour, we have also the lecturer's sentiments
respecting venesection and the exhibition of opium and ergot.
Although in the 2l8t lecture Dr Lee was at a loss to diseover what bene-
fit could result from our having in the first stage of labour ab accurate
knowledge of the position of the head, yet in his 24th discourse we have
an indirect acknowledgment that such information is extremely valuable.
By the position not having been recognised, either in consequence of the
sentiments of Dr Lee being acted on, or from inexperience, and the mal-
position not being rectified when this could be easily accomplished, an
un&vourable case is produced. Dr Lee, in speaking of such positions, is
obliged to confess that, ^ besides the great length of time which may be
required in moulding and expelling the head, there will also be a great
distention of the external parts," &c. ; in the second place, he remarks,
that **• if the labour is much protracted, and the natural powers be insuffi-
cientfor Us ex/wfoion," &c. ; and in the third place, he observes, that ** no
unpleasant consequence is produced except a swollen state of the child's
face firom Umg-ixmtinued pre^eureJ* But we shall immediately see that pro-
traction of the patient's sufierings, exhaustion of her pow^:s, and tume&c-
tion of the foetal structures, are not the only evils which will result from
non-interference, but frequently also the deadi of the foetus.
We are quite prepared to admit that in many cases of malposition, the
fiM^ during the advance of the head, turns in the direction of t^e sacrum
without artificial interference, but whether so frequently as Rigby and the
other disciples of the Heidelberg school have stated, is what we cannot
positively affirm. But, admitting this to be the case, would a practitioner
who had disscovered malposition at such a stage of labour as would easily
THEORY AND PRACTICE OF MIDWIFERY. 199
permit the required change, be justified in leaving matters to nature, and
the woman to be in agony from twelve to sixteen hours, when by very
simple interference this could be prevented ! We should like to ask Dr
Collins^ a gentleman in whose candour and experience we have implicit
confidence, whether, if he had been present at the commencement of each
of the twelve cases of labour with the face to the pubes referred to by Dr
Lee, he would have left matters to nature ! and if he would not, whether
he conscientiously believes that the half of the children would have been
still-bom ! Notwithstanding the opinions of Dr Lee and others of our
brethren, we hold that to advocate non-interference, under the foregoing
circumstances, would betray a degree of callous indifference to the suffer-
ings of the sex, of which, after mature reflection, it would be difiicult to find
an example. When such pernicious principles are attempted to be incul-
cated, Dr Lee and his proselytes could scarcely feel any surprise should the
London College of Physicians again declare to the Secretary of State for the
Home Department, "that the most successful practice of midwifery re-
quires no such laborious preliminary study " (as is necessary for the practice .
of medicine), " else discreet matrons and plain uneducated men in the
country, who frequently arrive at great notoriety in this calling, would not
acquire that credit which they often attain."
Dr Lee denies the influence of an oblique position of the os uteri in re-
tarding the first stage of labour ; while he as firmly believes that shortness
of the umbilical cord has this effect. Candour and practical experience,
not mere assertion, will decide these points. Let such of our brethren as
are sceptical regarding the influence of the first, merely introduce a finger
within the os uteri when it is directed against the sacrum, as sometimes
happens in first labours, and cautiously draw it into, and for a short time
retain it in the centre of the brim, when the rapidity with which it will
dilate must soon convince them of their error. Dr Lee's belief, that short-
ness of the umbilical cord will retard the expulsion of the foetus, is scarcely
worthy of comment, because not only the idea but the very words used by
the lecturer are borrowed without acknowledgment from Dr Denman, one
of the idols of the doctor's worship ; and because he unintentionally agrees
with us in thinking that it cannot have this effect, by admitting that, when
the funis is too short to permit the uninterrupted transit of the foetus, the
placenta will be detached or the funis itself ruptured, of which last Dr
Rigby relates a case exactly in point.
Although we have thus far, as it was our duty to do, exposed the &lla-
cies of some of Dr Lee's opinions, we do not hesitate, however, to admit
that his sentiments and practice relative to many important points contained
in the last five lectures are, to say the least, judicious, decisive, and such as
were to be expected from a practitioner of industry and experience. We
have noticed with satisfiiction his strictures on the employment of vene-
section, opium, and ergot ; and we are glad that the reckless practice of
incising the os uteri during labour, in cases of rigidity of that aperture, is
not even mentioned by him, whence we infer that he disapproves of it.
The 27th, 28th, and 29th discourses may truly be denominated multum
in parvo, and afford an additional instance of Dr Lee's aptitude for condensa-
tion ; for in these three lectures we have all his observations on the im-
portant subjects of the history, objects, and application of the forceps,
embryotomy, Cflesarian section, and the induction of premature labour. In
his introductory remarks on the application of forceps (lect. 28, p. 300),
the lecturer informs us that he " gives the preference, above all others, to
Dr Denman's short forceps covered with leather:'-^** But in truth I attach
200 THEORY AND PRACTICE OF MIDWIFERY.
coinpaiatively little importance to the shape and dimensions of the forceps
for use." Dr Lee could not hare promulgated a more dangerous senti-
ment regarding this instrument than that its size is a matter of little
consequence ; but fortunately we are saved the trouble of any lengthened
comment on this head by additional light having dawned on the benighted
intelligence of the lecturer in advancing with this subject ; for in the same
discourse, at p. 303, we have not only a complete contradiction of the fore-
going opinion, but what we are sure must be in accordance with the senti-
nienti of every practitioner pretending to a knowledge of the use of forceps.
" In order to disable young practitioners from running such risks
(causing inflammation and laceration of the parts), and to free myself from
the temptation of using too much force, / have always used and reeom-
mended the forceps so short in the handles that they cannot be used with
such violence as will endanger the woman's life," &c.
The objection, and an insuperable one, to the employment of forceps
of lengthened dimensions is the amount of power they confer on the
operator, than which, in the hands of gentlemen entering on practice, there
cannot be any thing more dangerous. This objection applies to all the
continental forceps we have seen, even to that used by the distinguished
professor at Heidelberg, though, from the eagerness with which he has so
long applied himself to the improvement of a branch of the profession of
which he is so distinguished an ornament, we had a right to expect that
the defect in question would not have escaped his penetrating mind. For
ourselves, we give the preference to the double-curved pair, which also is the
variety most generally used on the Continent, being originally the sugges-
tion of Levret ; and if the handles were lengthened by an inch, we do not
know, of all the piracies which the dabbUng manufacturers of forceps
have produced, a better instrument than that delineated in the work of
Dr Wallace Johnson, which on an impartial trial will be found, when pro-
perly applied, both more safe and efficient than the single-curved pair.
By a practitioner so ignorant of the subject that he is unable to decide the
precise position of the head, the single-curved is more easy of management,
since in such hands we know for certain that forceps are occasionally in-
troduced at random.
We concur entirely in the opinions of Dr Lee respecting the objects of
forceps, and his salutary precautions regarding their use ; but, in Mb
idolatry of Dr Denman, his sentiments in reference to these instruments
are blended with notions so antiquated, and with directions for their ap-
plication so utterly at variance with the experience of all competent practi-
tioners, Dr Lee himself excepted, that, were we not satisfied of the contrary,
we should certainly W inclined to infer that the author had much more
experience in craniotomy than in the application of forceps. To forceps
covered with leather, as recommended by Denman and preferred by Dr Lee,
we decidedly object ; firsts becaose this covering, by increasing the
thickness of the blades of the instrument (and particularly so after
their immersion in warm water), would render their intioduction more
difficult, or indeed impossible, in cases of limited free space, but in
which, without the leather, they might be introduced with comparative
ease, not only from less room being required, but frtim a polished steel
instrument sliding more readily over the linings of the pelvis than a
contrivance covered with a substance which would cause a greater amount
of friction ; and, «ecoiM%, because we presume it will be admitted that it
is quite possible, by means of an instrument covered with leather, to convey
morbid secretions from one subject to another.
J
THEORY AND PRACTiCE OF MiDWIFERY. 20t
If Dr Lee acts la private in accordance with the precepts which he incul-
cates In his public lectures, we have no hesitation in pronouncing him t(i
be one of the most indelicate and unfeeling practitioners we have read of
for some time. This we think tlie following passage from his 28th lectuirey
p. 307, on the application of forceps^ will fully substantiate : — ** Take a blade
of the forceps by the handle in your left hand, and pass aU the fingers </
ffour right hand, in a conical formy covered with iardy slowly imto the orifice of
the vagina^ and if it is ajirst chUdy and the parts we contractedy gently dilate
them and press back the peiinaum. When this has been sufficiently effected,
pass the four fingers of the right hand forward into the vagina deeplyy as far
indeed as the root of the thumb, between the head of the child and the front
of the pel vis," — " I would recommend you to pass all the fingers complete^
over the side of the heady so as to feel the ear, and to determine positively to
which side of the pelvis the occiput is directed." To what reflections the
foregoing passage may give rise in the breasts of the competent part of our
brethren, it is not for us to say ; but, for ourselves, we hesitate not to de*
clare our belief, from abunduit experience in the application of forceps^
that not one woman in fifty would submit to the tmnecessary and unfeeling
practice recommended by Dr Lee ; and that the pelvis is rarely indeed of
such capacity as to admit the adoption of the steps which he so confidently
inculcates ; but we shall be charitable enough to suppose, that from his
primeval origin nature intended Dr Lee for tiie profession of an accouch-
eur, and that, while she endowed him with the intellect of manhood, she
purposely furnished him with the hands and fingers of a child.
As an appropriate introduction to our observations on the conduct of Dr
Lee in performing embryulcia, we may here notice his directions for ascer-
taining the presence of deformities of the pelvis. *^ All the morbid con-
ditions of the pelvis can be ascertaiued with sufficient precision during life
by introducing the fore-finger of the right hand into the vagina, and
passing it around the interior of the pelvis. If the point of the finger
cannot touch the promontory of the sacrum, there is little or no distortion
of the brim ; and by moving the finger from side to side and backward, it
will readily be discovered if the tuberosities of the ischia are at the usual
distance from each other, and if the direction of the sacrum and coccyx is
altered." Lect. 2, p. 22. These directions for determining the various
vitiated conditions of the pelvis are miserably defective, and an insult to
the understanding of intelligent students. No sensible unprofessional
reader even, not to mention competent practitioners, would for an instant
suppose that so importcmt a point as that by which the necessity of de-
stroying a human being is to be determined, would be disposed of so sum-
marily by a master in the art.
We were in hopes of being saved the necessity of commenting on the
subject of embryotomy ; but here again we cannot conceal our dissatis£ebctioa
at the conduct of Dr Lee. In the course of twenty years he assisted at 127
cases of eAbryulcia, which amount of practice might be thought sufficient
not only to qualify him for deciding with little hesitation on the necessity
of the operation, and performing it with dexterity, but also for acting with
such caution and tenderness as to secure, as &r as human aid could accom-
plish, the safety of the parent. Far be it from us to insinuate even that
the head was, in any (me instance, perforated unnecessarily ; but we uo-
hesitatingly state that, in some instances at least, it was not done with
caution, and that consideration for the safety of the parent which ought
to have been observed, and which may perhaps explain in some degree th«
2o
202 THEORY AND PRACTICE OF MIDWIFERY*
mortality that followed the operation, 23 of the 127 operated on having
died after it.
In consulting Dr Lee's Clinical Midwifery, we find abundant evidence of
the fortiter in modo. Thus, in case 66, ^ Great force required to extract ;
case 76, great force required to drag the shoulders into the cavity of the
pelyig ; case 78, great force was required to extract the head after being
opened ; case 86, we were both thoroughly exhausted before the delivery
was accomplished ; case 129, after much exertion, continued for nearly two
hours, the head was at last extracted when completely torn to pieces ; case
136, great force was required to extract the head ; case 145, the head would
not follow — I pulled strongly upon the neck — ^the perforator and crotchet
were employed — the delivery was at last effected, but death took place
five days after from uterine phlebitis ; case 146, the bones of the upper
part of the head were all torn to pieces, and the fingers of my left hand
much injured, before the delivery was effected ; case 160, the point of the
crotchet was fixed on the base of the skull, and strong traction made for
aome time ; at last I succeeded in extracting the head with the bones all
crushed together. After this severe and tedious operation she was left in a
yery exhausted state, and died the following day with vomiting and other
symptoms of ruptured uterus. On examining the body after death, we
found the muscular coat of the anterior part of the neck of the uteros
lacerated. Case 161, though / exerted my u^wle farce In dragging down the
head, it would not pass." P. 36—76.
Had Dr Lee been contemporary with Philomenus, nothing more barbar-
ous was to be expected than the management of some of the cases specified ;
for the sole object of this last author, as would appear from the writings of
^tius, lib. xvi. c. 23, vras to extract the foetus in any way that this could
be accomplished ; and if we are to judge from Dr Lee's proceedings, per-
foration and the most forcible traction constitute in his hands the basis of
operative midwifery. Even Celsus, barbarous as the practice of midwifery
was in his day, would appear to have acted with more caution than Dr Lee ;
for he says, lib. vii. c. 29, ** Nam ei eummam prudentiam moderatkmemque
deeiderat^ et maximum perieuhim ctffert** Every one who has been concerned
in performing embryotomy must be aware that a considerable degree of
traction must be exerted fi>r the extraction of the foetus, even where the
confinement of the pelvis is not remarkable ; and therefore we do not
blame Dr Lee so much for the efibrts which he made, as for his having dis-
regarded the most important precaution previously to attempting delivery
^-of reducing the size of the bones of the cranium, that during their extrac-
tion the certainty of injurious friction against the structures of the parent
might be diminished. Neither does it appear, from the details of the cases
related, that, with a view to the preservation of the maternal structures,
evisceration of the thorax or abdomen had been practised. No one can
peruse this section of Dr Lee's course without observing that, like the late
1^ Fielding Ould and Dr Osborne, his grand aim is to show that the Ccsa-
rkn section may be dispensed with ; but although we are by no means
friendly to that operation, and readily admit that by foreigners it was, and
still is, resorted to where it would never be thought of by Britiah practi-
tioneis^ yet we are decidedly of opinion that no one can reflect on the vio-
lence which must have been inflicted on some of Dr Lee's patients, without
being satisfied that they would have had fully as good a chance of recovery
after the Ccsarian operation, and the additional advantage, in some of them
at least, of one life being saved.
THEORY AND PRACTICE OF MIDWIFERY. 203
In coaclading our strictures on cases requiring the crotchet, we cannot
pass unnoticed a statement made by Dr Lee in the 141st and two succeeding
deliveries* — ^that he introduced his hand and turned in a pelvis of which
the distance, estimated during life, between the tuberosities of the ischia was
only one and a half inch ; but although this patient died subsequently
under his management, the dimensions of her pelvis are not supplied, whidi,
to say the least, must place the candour of Dr Lee in a peculiar position.
As was to be expected, the observations of Dr Lee on the Cssarian section
are not only meagre in the extreme, but almost devoid of useful information.
Although we are as hostile to this expedient as he is, yet, as we are satisfied
^t practitioners may occasionally be called upon to perform it, his lectures
ought to have embraced a proper detail of the steps of the operation, since
it is quite possible that on some occasions an operator may have no other
work to consult.
We entirely agree with the lecturer as to the safety of the induction of
piemature labour in as fJEir as the parent is concerned, and that it ought to
be resorted to in all cases at such a stage of pregnancy as may be required,
according to the estimated amount of deformity in the living state, to pre-
vent our endangering the maternal structures by embryulcia, or the patient
belog compelled to submit to the Cesarian operation. But though punc-
turing the membranes^ when done with caution, may be safe as regards the
parent, yet we haye always been of opinion, and our belief is confirmed by
the results of some of Dr Lee's cases, that the early evacuation of the liquor
amnii is often destructive to the foetus, in consequence of the pressure to
which it is thereafter more directiy exposed from the contractions of the
uterus. Wherefore, when our object is to preserve the foetus, we have
always preferred to the perforation the separation of the membranes from
the uterus, — a practice which has invariably succeeded under our manage-
ment to induce premature labour. In perusing the observations of Dr Lee
en preternatural labours, it nowhere appears that he exhibited opium to
relax the uterus previously to his undertaking the version of the foetus after
the escape of the liquor amnii. We can conceive no good reason for his
dispensing with this invaluable agent under such circumstances, but the
very reverse indeed ; and we think that if it had been exhibited, Dr Lee's
cases of ruptured uterus would not have been so numerous.
The remaining lectures include the important subjects of uterine hemor-
rhage, convulsions, inversion of the uterus, rupture of this organ, inflamma-
tion of the organs of reproduction, phlegmasia dolens, mania, engorgement
and inflammation of the mamme, and ulceration of the nipples. Li the
perusal of these discourses there is little to find &ult with, for pathological
investigation appears to be the forte of Dr Lee, — as an obstetric practitioner
he aj^eazs to littie advantage. Of some recent opinions and practical im-
provements, however, whether from ignorance, jealousy of his contempo-
raries—one of his besetting sins — or because it would be derogatory to his
reputation, he takes no notice.
In bringing to a conclusion our analysis of Dr Lee's labours, it is not ne-
cessaiy for us to say that we are exceedingly disappointed, for this will be
read in almost every page of our observations. As a guide for students we
cannot recommend these lectures, especiaUy when those finished productions
of Drs Blundell and Bamsbotham can be consulted, which the prosy pre-
lections of Dr Lee resemble merely in name. We can aver that the die-
* Clinical Midwifery, p. 73«
204 ANATOMY AND PHILOSOPHY OF EXPRESSION.
eounes of Dr Lee do not contain any information of practical importance bir "
what must be perfectly familiar to snch of our Vi^ethren as poesesaa moder^
ate knowledge of the literature of their profession ; and, therefore, that o*
all the productions in midwifery which have recently issued from the preset
these lectures will be found, on perusal by competent judges, to be the leasfl
deserving of the honour of a place in a select medical library.
\
The Anatomy and Philosophy of Expression as connected with the Fine ArU,m=^r,
By Sir Charles Bell, K.H. 3d Edition, enlai*ged. 9vo,, pp. 26 4 .
London. 1844.
This elegant contribution to philosophy and the fine arts, was the eaillest^^B
and latest work of a distinguished anatomist, a man of taste and of genius^^"-
Although first published in 1806, it was originally composed during th w i ^
period of his studies, ** before the serious pursuits of life began." With the^^^
view of verifying the principles which it develops by the study of thc^^^
great masters in painting and sculpture, the lamented author yisited the^^^
Continent in 1840 ; on his return he recoroposed the whole work for a new— ^^
edition, and was engaged in its final revision for the press immediatel) ^^
l)efi)re his death in 1842.
Nearly the entire work has been re- written. What formed the inlit> ■*"
ductory essay of the former editions, forms the eoncluding one of thia^^ef^
which commences with a comparison of ancient and modem art, and a-^^^
sketch of the influences under which the masters of the Italian school-^^"**
studied and composed their great works. What may be called the formei -•" ^
work was more exclusively devoted to the relations of the subject to th e-*— ^ ^^
art of pMnting ; the present embraces a fuller analysis of the souxoes ot" - ^^
beauty and expression, and an examination of the theories of beauty in the ' ^=^
human countenance, and of ideal beauty. What was contained in the ^^=**^
former essays is mostly embodied in these, but extended and re-arranged ; '^c- >
and the whole work is enriched by illustrations derived from various ^^*
sources, and particularly from observations made upon the great works of *^^*- *
art examined by the author during his continental tour. The work has ^^
been edited, apparently with much taste and judgment, by Mr Shaw, ^^
surgeon to the Middlesex Hospital, by whom an Appendix has been added '^^
containing a review of Sir C. Bell's opinions on the nervous system ; the "^
part of the last edition which related to that subject having been erased by "
the author before he had produced a new essay to supply its place.
In the present edition a considerable number of the sketches whidi
illustrated the former ones are withheld. Although satisfied that this has
been done with discrimination and taste, we can scarcely avoid regretting
that they were not retained. Some of tiiem were certainly rather fimcifdl
and overdrawn, but they were valuable as the realization, in some degree,
of the ideas and principles of the writer, and bore the marks of that genius
which was almost always perceptible alike in his writings and his sketches.
The best of the engravings of the former editions, however, are all retained,
a&d to these have been added several new vignette illustrations of great
beauty and spirit. Of these we were particularly struck vrith the h^ of
a child in p. 17, and the bust of a man in p. 162 ; — they are accurate in
drawing, and full of expression and beauty. If we were inclined to be
ANATOMY AND PHILOSOPHY OF EXPRESSION. 205
hypercritical, some &iilt8 in drawing might he pointed out, a?, for instance,
the outline of the forearm in the figure p. 210 ; hut it would he unjusti-
fiable to criticise severely the posthumous work of one who undoubtedly,
was no mean artist, and of whom our sad conviction is, that if he had sur-
vived to see his favourite work re-published, it would have appeared with
many embellishments, now for ever lost to the public, selected from the
exquisite sketches made by him during his visit to Italy.
The anatomy and philosophy of expression have relations to physiology,
and to the duties of the practical physician, not less than to the fine £^.
It is in this view, as well as because we .claim a peculiar interest in all the
writings of so distinguished a member of the medical profession, that we
notice a work of this kind in a journal of medical science. The aim and
design of the author are not only to enforce the study of anatomy on the
artist by pointuig out its advantage in drawing the human figure, but to
investigate the sources of beauty and expression by an inquiry into their
relation to the interior structure and functions of the body.
Following our late distinguished townsman, the author of the " Essays
on the Nature and Principles of Taste," Sir Charles Bell traces the beauty
of the human countenance to the association of ideas — to the capacity for
expression, or the emotions or thoughts of which it is expressive.
" A face," he observes with much truth, " may be beautiful in sleep,
and a statue without expression may be highly beautiful. On the other
hand, expression may give charm to a face the most ordinary. Hence it
appears, that our inquiry divides itself into the permanent form of the head
and face, and the motion of the features, or expression.
^ But it will be said there is expression in the sleeping figure or in the
statue. Is it not that we see in these the capacity for expression — that our
minds are active in imagining what may be the emotions of these features
when awake or animated \ Thus, we speak of an expressive face before we
have seen a movement, grave or cheerful, or any indication in the features
of what prevails in the heart." * * ♦ « a. countenance may be distin-
guished by being expressive of thought, that is, it may indicate the posses-
sion of the intellectual powers. It is manly, it is human ; and yet not a
motion is seen to show what feeling or sentiment prevails. On the other
hand, there may be a movement of the features, and the quality of thought,
— afi^ion, love, joy, sorrow, gratitude, or sympathy with suffering, — ^is
immediately declared. A countenance which, in ordinary conditions, has
nothing remarkable, may become beautiful in expression. It is expression
which raises affection, which dwells pleasantly or painfully on the memory.
When we look forward to the meeting with those we love, it is the illumi-
nated face we hurry to meet ; and none who have lost a friend but must
acknowledge that it is the evanescent expression, more than the permanent
form, which is painfully dear to them." Pp. 20, 21.
In the examination of the relative proportions of the cranium and face,
some curious foots are pointed out, not generally recognised by anatomists
or artists. The idea is generally entertained, that in the different varieties
of mankind the development of the cranium bears an inverse ratio to that
of the &ce ; that as the capacity of the cranium diminishes, that of the face
increases, and vice versa ; that the cranium grows as it were at the expense
of the fece. Sir Charles Bell here shows, by reference to experiment,
that, on the contrary, the negro face, e,g.y is actually smaller than the
European, considered in relation to the cranium (p. 38), and that the
apparent difference and real distinction between them, besides the difference
JJ06 ANATOMY AND PHILOSOPHY OF EXPRESSION.
of abaolttte size of the cranium^ is in the greater development in the n^gro,
not of the whole face, but of the parts immediately concerned in maHication
alone.
The imperfection of the facial angle of Camper as a means of determin-
ing the relative dimensions of the cranium and £ace is acknowledged ; not
sOy perhaps, the idea that this angle, if increased to a right angle or an angle
of 90% fails to confer on the face the beauty or grandeur of the antique.
** Camper's position is this, — ^that as by the diminution of the cranium
and the further inclination of the facial line the head is depressed in char-
acter to that of the negro ; so, by raising and throwing the skull upwards
and forwards, untU the facial Ihie reaches the perpendicular, as in the pre-
ceding page (referring to a sketch of a very beautiful Mercury from the
antique), the great object is attained of resemblance to the antique head.
But Ids own figures contradict his conclusion ; for although he has
thrown the head forward in them, even beyond the perpendicular of the
facial line, yet, as he has preserved the features of common nature, we
refuse to acknowledge their similarity to the beautiful forms of the antique
marbles. It is true that, by advancing the forehead, it is raised ; the face
is shortened, and the eye brought to the centre of the head. But with all
this, there is much wanting, — ^that which measurement or a mere line will
not show us." Pp. 28, 29.
Our author accordingly traces the source of beauty in the antique
statues to the delineation of those features which are associated in our
minds with the possession of the nobler feelings and higher intellectual
qualities of our nature. As speech is one of the greatest marks of dis-
tinction between man and brutes, so the greater or less development
and adaptation of those organs which are designed for the use of that
faculty is peculiarly associated with manly beauty. The adaptation of
the lips for articulation and expression, of the nose and frontal anuses
for the manliness of the voice, and not their nze, distinguish those organs
from the purely wvuual oigans of the lower animals. So of the eye
and ear.
Discarding altogether the belief in the existence of such an abstraction as
that of an ideal beauty, or of any notion of divinity other than can be de-
rived from the contemplation of humanity^ Sir Charles contends that tiie
representations of divinity of the ancient sculptors owe their grandeur to
the exaggeratioiii of those features which are by us associated with the nobler
qualities of mind ; and that the ideal beauty of the ancient masters in
painting was arrived at by the delineation of those features which are asso-
ciated with the pleasing emotions and purer virtues of the heart.
** With the view of attaining beauty, the artist is not to slight nature or
to avoid it^ but to study it deeply as the only source of Improvement. He
must not only contemplate those beauties which we may suppose to stand
before him, but consider where they differ from others leas admirable. How
beautiful that smile I how eloquent those lips ! Let him ask Jiimylf in
what this consists. Smiling and ^eech are chaiacteiistic of man, and are
bestowed to express the affections of the heart and communicate thoughts.
Give to the mouth the capacity for these. Observe the forehead and the
defb&ed eyebrow ;^-'What is there in nature superior ! Let liSiw T^MM'k them,
and then raise and throw forward the forehead, a feature especially hnwiim
and elevatipg to the countenance. Now he sees that depth is given to the
eye; that the shadows fiill with bold relief; the eyebrow acquires more
freedom, stands in a finer arch, and is more expressive of agreeable emotions.
ANATOMY AND PHILOSOPHY OF EXPRESSION. 207
Aqd thus he passes froin point to point, — ^from one feature to another — ^the
nose— the ear ; exaggerating a little the outline of whatever indicates the
higher and purer qualities, and avoiding what is low, or whatever is asso-
ciated with the baser human passiona or with the form of the brutes ; and
by insensible gradations, and long contemplation of what is highest and best,
he acquires from nature that idea which is in his mind the perfection of
form." Pp. 68,69.
In Essay IIL the author goes on to examine those sources of expression
which cannot be explained on the idea of a direct influence of the mind
upon the features ; and here he develop? and illustrates very beautifully his
ideas regarding the muscles of respiration being in a peculiar manner the
organs of expression. The mind actmg upon the heart, and that upon the
ciitsulation through the lungs, produces all those uncontrollable signs of
emotion which are the indications of human passion. " At the instant of
our birth an association of muscles is formed, and at the same time put in
operation, stamping a character of expression, which betrays the wants of
the body in early infancy, and the suflFerings of the mind in the after-
period. The frame of the body, constituted for the support of the vital
fanctions, becomes the instrument of expression ; and an extensive class
of passions, by influencing the heart, — ^by affecting that sensibility which
governs the muscles of respiration, calls them into operation, so that they
become an undeviating and sure sign of certain states or conditions of the
mmd. They are the organs of expression."
" Returning now to the contemplation of any of the stronger passions, we
comprehend much which was before obscure. We see why that grief which
strikes the heart should affect the regularity of breathing ; — why the muscles
of the throat should be affected with spasm ; — why slight quivering mo-
tions pass from time to time over the face, the lips, and cheeks, and
nostrils ; — ^because these are the organs of respiration, — organs which have
their muscles united to the sensibility of the heart, and moved under its
influence. Now we comprehend how the passion of rage or terror binds
and tightens the chest, — ^how the features are so singularly agitated by the
indirect as well as by the direct influence of the passions, — how the words
are cut, — ^how the voice sticks in the throat, — how the paralysed lips refuse
the commands of the will, so that they are held in a mixed state of violence
and weakness, which, more than any flxed expression, characterizes the
inflaence of the passion." Pp. 94, 95.
The two following essays are devoted to a description of the muscles of
the face in man, and a comparison of them with those of the lower
animals. Admirable and accurate as the remarks generally are on the
actions and uses of the various muscles of the face, we cannot refrain
from remarking, that the descriptions of them are far from being suf-
ficiently full and minute for a work specially devoted to this subject ;
nor are the wood-cuts which accompany the letter-press calculated to
supply the defect by giving accurate delineations of the muscles. Nor
have we ever been able to understand how the action of the oblique
muscles of the eyeball has been made to contribute to the support of the
so-called respiratory system of nerves. Neither the superior oblique
muscle alone, which is supplied by the pathetic nerve, nor the two oblique
acting conjointly, could ever produce those *• upward glancings of the
eye," which are referred to them, and to the influence of the respiratory
nerves.
We are hardly prepared, either, to disinherit the lower animals of all
208 ANATOMY AND PHILOSOPHY OF EXPRESSION.
but instinctive emotions. Although less expressive than the ^'haman &ce
divine," we are strongly prejudiced with the belief that they have their
feelings and emotions as well as ourselves, and that their faces possess, if
we fully understood and studied the index, the means and capacity of ex-
pressing them.
Of the essays which follow^ on the expression of the various passions,
of expression in reference to the body, of the study of anatomy as neces-
sary to design, and of the uses of anatomy to the painter, we cannot ex-
press ourselves in terms of too high commendation. They are characterized,
with some &ults of recapitulation and want of system, by great beauty
and truthfulness ; — they display the nice discrimination and taste of the
artist, the feeling and sympathies of the man of genius, and the reflection
of the philosopher. Interesting as they must be, and truly valuable to the
painter and sculptor who would make nature his study, a perusal of the
observations cannot fail to interest the physiologist, and to benefit the
physician. Such habits of observation and reflection as they are calculated
to inspire would prove of infinite service in the detection and diagnosis of
disease, — in the acquisition of that nicer tact — ^the vUus erudUus — ^which
is or ought to be the peculiar characteristic of the accomplished physician.
1. Bemarks on Schools of Instruction for Military and NawU Surgeons^ in a
Letter to the Right Hon. Sir Robert Peel. By Sir George Ballingall,
Regius Professor of Military Surgery in the University of Edinburgh.
1843.— 2. Catalogue of the Museum attached to the Class of MiUtary Sur-
gery in the University of Edinburgh. 1844.
It requires but a very superficial acquaintance with the history of mili^
tary campaigns and naval expeditions to discover how much their success
depends on efi^ctive measures being adopted to preserve and restore the
health of the forces employed. Nor can such measures be always alike ;
they must be varied with the varying circumstances of warfare. It is true,
the care of the health of armies and fleets ultimately rests on the great
rules applicable to diseases and injuries in civil life. But there must be a
great amount of practical knowledge, to be acquired only from the reports
of those who have been in actual service, requisite for carrying those rules
into efipect with the best advantage in circumstances so difierent from those
under which medicine is practised at home. To collect, arrange, and teach
this description of knowledge is the peculiar object of the medicine of fleets
and armies, generally known by the restricted name of Military Surgery.
There never was a country so situated as to have stronger claims on it for
the encouragement of this branch of medical study than the United King-
dom. True, we enjoy the blessing of peace ; but we firmly believe we shall
never retain that blessing otherwise than by being armed cap-a-pie for war.
By well-appointed armies and fleets we obtained peace, and by nothing less
can it be maintained. But our colonies and distant possessions aflbrd nearly
the same room for the exercise of fleet and army medicine, so to speak, as if
we were engaged in actual war. Our soldiers and sailors are exposed on
distant shores to unusual vicissitudes of temperature and climate, — to the
burning sun and drenching rains of tropical countries, — ^to ever- varying epi-
demic influences, — to marsh eflluvia, — ^to confinement on shipboard in tedious
voyages ; and are therefore at all times nearly as liable to those scouiges of the
MILITARY AND NAVAL MEDICAL SCHOOLS. 209
camp-fever, ague, dysentery, cholera, &c. — as in war time. The hospital*
service in the British army and navy may be as severe in time of peace as
in time of war. The newly appointed hospital mate^. trained merely in the
ordinary schools, may know how to treat gun-shot wounds without any
material error ; — ^yet even here not less skilfully because he has listened to
the instructions of one who has been familiarly conversant with such acci-
dents, or whose collections of their effects^ in the form of preparations,
enable him to show the main points in which the treatment of some of them
deviates from the rules applicable to the same kinds of injury otherwise
prodoced ; — ^but to all that concerns the peculiarities of an army surgeon's
duties^ — ^the- direction of hospitals, the moral treatment of a class of men to
whose habits, modes of thinking, and contrivances for deception and the
like, he must be an utter stranger, — ^not knowing even where to seek for
information, if his education lias been confined to the walk in which those
designed for practice at home study. No doubt the hospital mate soon gets
into the routine of the service ; but if that routine has sprung up under the
mere force of circumstances constantly changing, what chance is there that
it is as well founded as it might be, did it rest on the well-considered plans
of men chosen for their experience and ability to superintend such instruct
tion, and who would necessarily check each other's peculiarities and errors
of judgment by a free intercommunication of knowledge ! The division of
labour has worked wonders in many departments of human knowledge ;
and there is no reason to doubt that its effects might be made as conspicu-
QUS in fleet and army medicine as in any other department.
These reflections have been suggested to us by the perusal of Sir G.
BalUngaH's letter, addressed to Sir R. Peel, on schools of instruction for
military and naval surgeons. Sir George's object is to show the expediency
of establishing a professorship of military surgery in the two other metro-
politan cities as well as in Edinburgh. Our limits prevent us from extract-
ing any part of this letter, which is the less necessary, because Sir G.'s views
sufficiently appear in his reply to the strictures in the Medico- Chirui^cal
Review on his letter. This reply will be found stitched up with our present
number at the end, and to it we beg to call the attention of our readers.
Among the other praiseworthy exertions of Sir Geoi-ge to promote the
object of the chair which he fills, is the foundation of an illustrative museum.
We have before us a catalogue of that museum recently printed, and an in-
spection of the museum itself has gratified us very much. The university
has lately enabled Sir George to make a large addition to it. There is
much in it to interest medical officers in the public service, bearing on va-
rious departments of their duties ; but what gives a particular value to the
museum is a collection of considerably upwards of a hundred preparations,
made literally on the field of battle by Mr Rutherford Alcock, during the
service of the British Legion in Spain.
. There are thirteen preparations showing the efiect of musket balls, frag-
ments of shells, &c., on the bones of the head and the dura mater ; seven
showing the effects of the same on the vertebrte and ribs ; three on the >
bones of the pelvis ; eleven on the bones and joints of the upper extremity ;
forty-five on those of the lower extremity ; besides many others in illustra^
tion of the effects on the boneJs of amputation, exfoliation, exostosis, &c.
Several preparations show the efiects of gun-shot wounds on the bmin and
nerves^ others the effects of the same on the thoracic and abdominal viscera,
others on the blood-vessels. Altogether this part of the museum appears
to us to be unique, and calculated to be of the greatest practical use. We
2»
t
210 APPLICATION OF PRISMATIC REFLECTION
have heard of nothing to be compared to it elsewhere. We trust the xix^d
cal officers of the army and navy will second Sir Greoi*ge's efforts, an<i ^^
to this interesting collection a» opportunities offer.
On the Application of** Prismatic Reflection " to the Investigation o/DU^^
situated in the Open Cavities of the Body, By Dr Warden, F.Er.C. S. ^E^
Edinburgh.
Much difficulty has hitherto existed amongst the profession generally^ in
the obtaining of a satisfactory, simple, and generally useful method £cyr
aiding them in the investigation and diagnosis of the diseases affecting tlie
deeper seated parts of the open cavities of the body ; and though the prin-
ciple and means here proposed may not, in every instance, fully realize our
expectations, yet the principle is by far the most simple and elegant of any
that has heretofore been applied. The means recommended for effecting'
this purpose are based on the principle of illumination by means of totally
reflecting prisms of flint glass.
These prisms are fitted on a speculum adapted to the cavity which it is
desirable to explore, and the direct sun's rays, or even those from an un-
shaded side-light, falling upon one plane of the prism, become totally
reflected by the other, and are transmitted along the centre of the speculum.
Dr Warden particularly notices its application to the investigations of the
morbid conditions of the auditory passage, and for which he has also de-
vised an instrument. " It is formed," says he, " with the view of ^ts
being adapted not only to the different development of the organs of hear-
ing in youth and age, but also so as to form a series of dilators, applicable to
the removal of strictures, upon the same principle as regulates the treat-
ment of the same disease in other situations."
** The instrument devised and represented in the accompanying diagram
consists of a straight handle, a a, five inches in length, terminating i^ *
ring, 6, of half an inch internal diameter, the ring grooved in its interior *8
a screw. To this screw are adapted four canulae or straight tubes, c, of four,
three, two, and one lines calibre, and another, d, of a funnel or tapering
shape, applicable for preliminary exploration, and removal of any accum^"
lated cerumen obstructing the passage of the light, also for affording a p^^
per field for the passage of instruments, and other topical manipulation*
From the middle of the straight handle arises a curved branch, c, moveal>l®
in a pivot joint at/, toward either side of the handle. This branch fort»8
a stidk on which a prism of flint glass, g, is perched erect, to the level of
the opening of the affixed canula. The prism rests in a metallic socket,
and is made to revolve on its own axis at the touch of the finger, or to ^*
main fixed in any desired position, by the aid of a small clamping screw, *•
The instrument is thus complete for use. The canula is to be introduced
into the ear to be examined, the patient being seated, exposed to a goO"
light. The surgeon placing himself conveniently opposite to the side of the
patient, a face of the prism is turned towards the light, and it is made t^
revolve until the luminous spectrum is conveyed to the bottom of the canul^
and to the surface sought to be observed. There is no difficulty in tn®
adjustment of the position when the new relations of the light and of th«
object are familiarized by a little experience ; and when once this adjust-
ment is made, the full and clear illumination of the object is at once ob-
TO THE INVESTIGATION OF DISEASES,
PRISMATIC AURI800PE.
211
212 APPLICATION OF PRISMATIC REFLECTION
tained, and with a degree of brilliancy exactly proportioned to the quar^ -tity
of light employed in the particular observation.
" The principle or theory consists in total reflection : the light is received
by one side of the prism, is reflected from the second side, and emeiges by
the third side to the object illuminated, as represented by the dotted lines
O! y as, and whence its View is revealed to the eye. The illumination is not
preternatural or dazzling, such as would alter the real features of dise-ase,
but natural, and such as the eye is familiar with. The advantage of -fchis
flat natural light will be fully appreciated by professional eyes ; and I «in
persuaded, from ample experiment, that any means of concentrating 1 ight
by lenses, or converging mhroiTS substituted for the prism, would not im-
prove the serviceableness of the instrument exhibited, although by iJieir
subsidiary employment they may be made to contribute to its efficiency,
whenever, under extraordinary circumstances, more intense L'ght isi re-
quired.
" The method of illuminating diseased parts by the medium of the prism
is relieved from the intricacies inseparable from the employment of a
reflecting speculum, whose curve must be anew adapted by the manufacturer
to the focal distance of the object to be viewed, otherwise it is indistinct
and distorted, as in a false mirror. Neither is the method invented by me
liable to the objections applicable to various ingenious contrivances for the
same end, which we owe to distinguished members of the profession. By
the convenient position of the light in prismatic illumination, it is not
liable to be intercepted by the sliadow of the observer, as is the case with
any direct light proceeding from behind him, — a disadvantage we are not
free from even where sunlight is employed ; and if a lamp and lens be
placed between the eye and the object viewed, not only does the dazzling
artificial medium alter the characteristic aspect of disease, but such appara-
tus, in order to guide any surgical procedure, must be kept strictly in such
a position as necessarily to interfere with any convenient measures in the
removal of foreign bodies, or other manual operations. By a construction
of instmment suited to the situations of disease in the different cavities,
increased facilities in surgical practice, I feel warranted in asserting, are
largely attainable through the adoption of the method proposed by me.
** I may mention also, that I have satisfied myself by varied experiments
that a totally reflecting prism placed in the angle of a bent canula, and
illuminated by a second prism, in the manner already described, i^vill afford
a satisfactory view of objects whose situation precludes the possibility of
direct observation — ^such as the opening of the Eustachian tube and of the
glottis, the position of foreign bodies detained in the throat, &c. For the
sake of illustration I may state, that by a simple arrangement, consisting
of two tubes, each twelve inches long and one inch diameter, embracmg
at their point of junction, at right angles* to each other, a right-angle<*
prism, I have been enabled to make inspection with the utmost accuracy
of exquisitely coloured drawings of the morbid anatomy of the eye ; ob-
taining by the arrangement described a reflection of the image presented
at the opposite extremity of such an instrumentj and that in all the bril-
liancy of sunlight view.
** Furthermore, I find that a diseased surface can be accurately inspected
at the extremity of a straight tube of twelve inches long and a quarter of
an inch diameter ; and I indulge the hope, that within this range a more
satisfactory treatment of highly seated strictures and diseases of the straight
|[Ut, as well as of diseases of the urinary organs, may be thereby attained*
i'O THE 1N*VESTIGAT10N OF lilSEASES. 213
That the latter expectation is not altogether visionary may be inferred
from the fact, that the straight canula of the brisepierre of Baron Heurte-
loup has a diameter of one-third of an inch." — Medical Gazette^ May 24,
1844.
Of the great utility of the application of the principle of prismatic re-
flection and illumination, as above proposed by Dr Warden, there can be
no doubt ; but as to the construction of the instrumental part of his
auriscope, we do not think it calculated to be so generally useful. In cases
of impaction in the meatus of any foreign substance, or when a polypoid
growth is to be removed from the deeper portions of this tube, we do not
think it could be used so advantageously as the common funnel-shaped and
double-handled speculum of Kramer. If, therefore, the prism weie to be
mounted on this latter form of instrument, it would £EicUitate, more than
at present enjoyed, tlie application and advantages either of natural or of
artificial illumination. We consider that the most important advantage
gained to the practitioner by the use of prismatic reflection arises from the
facility with which the recesses of the open cavities of the body can be affected
by means of a side light. This facility holds good in whatever cavity the
illumination may be required ; and Uius the interposition of an artificial
lamp between the eye of the examiner and the tube of the speculum being
avoided, his eye will be less obscured, as also less dazzled, and, what is of
still greater importance, one of his hands will be at liberty, so as to perform
without the aid of an assistant any further examination or operation, if
required. The profession are certainly deeply indebted to Dr Warden for
his ingenious, simple, and elegant application.
ANALYTICAL CHEMISTRY.
As there are few of our professional readers, especially those in the
country, who may not be called on at some time to execute chemical
analyses, in cases of poisoning or the like, and as duties of this kind are
certaui to devolve on the medical officers of the army and navy when on
distant stations, we recommend to their notice the following treatises : —
Eementary Instruction in Chemical Analysis, by Dr C. R. Fresenius,
Chemical Assistant in the Laboratory of the University of Giessen.
Edited by J. L. BulLogk. London, 1843.
Elements of Chemical Analysis, Inoi^ganic and Organic, by E. A. Pabneli«,
Chemical Assistant in University College, London. 1842.
Traite .Pratique d' Analyse Chimique, par Henri Rose, traduit de
r Allemand sur la quatrieme edition^ par A. J. L. Jourdan ; accompagn^
de Notes et Additions par E, Peligot. A Paris, 1843.— (A Practical
Treatise on Chemical Analysis, by Henry Rose (of Berlin), translated
from the fourth German edition, by A. J. L. Jourdan ; accompanied by
Notes and Additions by E. Pelioot. Paris, 1843.)
Dr Fresenius' work is an excellent treatise extensively employed in
the practical chemistry sdiools of Germany, which we can reconmiend as
of great value so far as it goes. It treats however solely of qualitative
analysis, and the translation, though clear enough, is awkward and inelegant.
214 ON THE STRUCTURE OF THE NERVOUS SYSTEM.
Mr Pamell's treatise is in all respects the one best suited to most readers,
as it is not more expensiye than the work of Fresenios^ and includes quauti-
tative as well as quaUtatiye analysis. It is the most recent English work
indeed on the former branch of the art, and contains the latest improve-
ments up to the date of its publication.
Rose's book is much ampler than either of the others, and is the ac-
knowledged text-book of Europe in inorganic analytical chemistry. We
haye an excellent English tramslation by GrifBn of the first German
edition of 1829, but it is now nearly out of print, and the originai
work has been increased by almost a third since the translation
was made. The French translation being from the fourth Grerman edition,
and furnished with notes from the well known chemist P^ligot, is much
superior therefore to it.
Part III— PERISCOPE.
ANATOMY AND PHYSIOLOGY.
On the Structure^ Relations, and Ftinctims of the Nervous System.
[Continued from our last.]
** Experiment 5. — ^The cord alone was divided in ihe fourteenth and also
the twentieth segment, and the interyeniug portion was destroyed by
breaking it down with a needle. The animal exhibited in the anterior part
of its body all the evidences of perfect volition. It moved actively along,
turning itself back on either side repeatedly, as if to examine the anterior
wounded portion, which it felt again and again with its antemue, and when
attempting to escape, frequently turned back as if in pain and aware of some
hindrance to its movements, but it seemed perfectly unoonscioos of the
existence of the posterior part of its body, behind Uie first incision. In
those s^ments in which the cord was destroyed, the l^s were motionless,
while those of the posterior division, behind the secoi^ indaion, were in
constant but involnntaiy motion, the movements being similar to those of
walking or running, uniformly continued, but without any consentaneous
action with those of the anterior part, by which locomotion was performed,
dragging the posterior divisions of the body after them. When the animal
was held by the posterior segments, reflex actions were excited in the legs,
and po werftil contractions and gyraUons of the whole animal weie peifonned
in those s^;ments ; but these movements appeared to be entirely the result
of reflex actions of the muscles, since exactly similar ones took place in the
whole body in deccqpitated specimens. At the expiratkMi of iweive hours the
most perfectly voluntaiy acts were performed by the head and anterior
division of the body, such as locomotion forwards or to either side, avoidance
of any obstacle, touching it with the antennc, which were in rapid action
as in an uninjured animAl^ und attempting to readi and rlimli up an obstacle
presented to it, but not in immediate contact with it. Bat reflex motions
alone existed in the posterior divKskm, in which the legs were veiy slowly
moved, even whan the animal was not progressing. B^sk actions were now
more easily excited in them than at first, either by contact with the segments,
by initation of one w two of the leg$ themselves^ or by a sudden cuient of
ON THE STRUCTURE OF THE NERVOUS SYSTEM. 216
air. By these means, when the animal was lying still, actions were imme-
diately excited in all the legs of the posterior part of the body anterior and
posterior to those which were irritated, and these actions were induced in
those of both sides of the body, but appeared to commence on the opposite
side, in the legs corresponding to those which were first irritated. In
eighteen hours the anterior part of the body was quite dead, no motions
whatever could be excited in it, either voluntary or reflex, but reflex actions
were then readily excited in the posterior, and also slightly so by mechanical
irritation, even at twenty-four hours."
** Other experiments were now made on the brain itself without detaching
the head of the animal from the body."
** Experiment 6. — The brain was completely divided longitudinally in the
centre by a fine pair of scissors. All power of recognising obj ects was imme-
diately lost. The antennffi were perfectly motionless, and the animal at
first moved directly forwards, as in the first and second experiments,
dragging the antennse along with it at the sides of the head. It passed on
with the head, first segment elevated, and climbed over every slight obstacle,
and when opposed did not turn to the right or to the left, but passed forwards
with the legs moving rapidly as in the act of running. At the expiration
of half an hour it had regained a little of the power in the left antenna, and
then constantly moved in a circle to the left side. When either antenna
was pinched, a sudden convulsive movement was induced in the whole body,
but the antenn© were not retracted when touched, as they always are by
the uninjured animal. At the expiration of an hour, slight motion was
regained in both antennae, but the movements to the left side were still con-
tinued. The brain was now entirely destroyed by a needle. All power of
vohtion, which seemed to have been partly restored, as well as the use of
the antennee, were instantly lost, and the movements of the legs and body
were precisely similar to those already seen in the decapitated specimens.
Pinching the antenn® did not occasion the slightest convulsion of the body,
or reflected movements of the legs, but slight pressure on the segments
immediately induced them, and also violent contortions of the whole body,
especially when applied to the anterior segments. In this specimen the re-
flected movements were excited at the expiration of eighteen hours, but
mostly so, at that time, at the posterior extremity of the body."
« Experiment 7.— The brain was divided in the middle, and one lateral half
with the antennal ganglion and optic nerve were removed. Some of the
motions of the antenna of the unmjured side seemed to indicate the remams
of volition. The animal coUed itself up and remained quiet as m health,
but the posterior legs of the body were in constant motion. The power of
recognising objects appeared almost entirel^^ destroyed. When the remam-
ing lobe of the brain was irritated with the pomt of a needle, the body was
agam extended and excited to slow progression forwards, exactly as m the
preceding experiments, but the power of moving was very feeble. At the
expiration of two hours, the specimen having remained undisturbed in the
interval, slow progressive movements in a circle were induced by pressure
on the segments, and always in the direction of the injured side, the left in
this specimen."
" Experiment S.—The lobe on the right side of the brain was removed,
and the results were precisely similar to those of experiments 6 and 7, and
the movements were to the righty the side injured m this specimen."
« Experiment 9.— The right eye and optic gangUon were both destroyed by
puncturing with a fine needle. The antenna of that side of the head became
216 ON THE STRUCTURE OF THE NERVOUS SYSTEM;
completely motionless, and perception of objects was destroyed ; but the
animal still retained its voluntary powei's, and was able to recognise objects
on the left side, on which the antenna and eye were uninjured, and seemed
to a great degree to retain their powers."
" Ejpperiment 10. — Both antennse were cut oflF close to the head, leaving the
brain uninjured. All the powers of the animal continued perfectly volun-
tary, and it sought or avoided objects as usual, but by means of the palpi and
vision, with not the slightest indication of reflex movements. When the
point of a needle was passed in at the antennse, the animal gave indications
of great pain by its movements, but these were not reflex. When placed on
the table it again sought objects, and carefully avoided falling over, by
changing its course when it arrived at the edge. The brain was then destroy-
ed through the insertion of the antenne, and the movements immediately be-
came reflex, and soon ceased, except when they were artificially re-excited."
** Experiment 1 1 . — The eyes on both sides of the head were removed without
injuring the brain or antenns. Volition continued perfect, but the movements
of the animal were slower, and all objects were explored with the antenn* ;
and it avoided nothing except when in direct contact with it or when its
presence had been ascertained by means of these organs. But immedmtely
the needle was passed into the brain, all the motions became reflex, and
precisely similar to those already detailed."
" These experiments seem to lead to the conclusion that the seat of volition
is solely in the supra cesophageal ganglia of these animals, since all direction
of purpose, all avoidance of danger, all control over the movements of the
body, either of speed or change of direction, are lost when these are much in-
jured or removed. Volition quickly ceases when they are severely wounded,
and is greatly diminished even when one only is slightly aflected. This latter
fact is indicated by the loss or diminution of purpose, and by the gyratory
movements of the body. The experiments seem also to show that sensation
may remain after the injury or removal of one lobe of the brain, as was
proved by the retraction of the antenna when slightly touched on the
uninjured side of the head, and by the cleansing and excited act of drawing
it constantly through the mandibles ; and further, that pain is felt when the
cerebral lobes are injured, as when the needle was applied to them after the
antennffi had been removed. They lead also to the conclusion, that all the
phenomena which occur in the posterior parts of the body after the brain
and cord have been separated are reflex or excited, and that these are most
intense at the two extremities of the cord — the medulla oblongata, and the
terminal ganglion ; and farther, that the reflex phenomena are always
excited and do not occur spontaneously, and that their intensity is greater
in proportion to the stimulus applied, and gradually diminishes until they
entirely cease, or are re-excited, precisely as already shown by Dr Hall in
the vertebrata."
" These experiments seem farther to show, that the reflected movements
cease first in the anterior part of the cord and its ganglia, and that they are
retained longest in the posterior ; that the movements are most powerful
and continue longest when the cord is entire, the brain alone being separated
from it ; and that they entirely cease sooner in proportion to the greater
number of parts into which the cord is separated : further, also, that the
reflex phenomena are less readily excited in the anterior part of the cord,
while it is still in connexion with the brain, and that they cease entirely
soon after the cessation of volition in that organ, as in those experiments in
which only a very short portion of cord was removed with it from the body,"
ON THE STRUCTURE OF THE NERVOUS SYSTEM. 2l7
'* Many of the phenomena are precisely simUar to those which have here-
tofoi'e been observed in the Crustacea. They agree in the circumstance
that violent contractions of the segments and limbs, both anterior and pos
terior to a ganglion^ are induced by irritation of that ganglion both when
connected with the brain and when insulated from it, thus proving these
movements in the latter instance to be reflex ; but there is as yet no direct
fro^ that sensation does not also exist in these ganglia."
'* The general results of these experiments tend to confirm the beL'ef that
the fibres now pointed out in the composition of the cord and ganglia, and
which cannot be traced to the brain, are those by which these movements
are executed independently of that oigan ; and further also, that the reflex
phenomena are most intense, most easily induced, and are of longest duration
in those animals of low organization, in which the volume of brain bears the
smallest proportion to that of the whole nervous system, in which also
volition and sensation ai'e of small iunount, and which have the body formed
of the greatest number of similar uniform parts or segments."
SURGERY.
Academy op Sciences, March 4, 1844.
" Keratoplastie:*
M. Feldmann presented to the academy a second memoir on Kdratoplastie
(transplantation of the cornea), containing the results oi twenty keratoplas-
tic experiments performed in the lab(»ratory of M. Flourens^ at the Gaiden
of Plants.
M. Feldmann announces, under the form of a general proposition, that .
Keratoplastie is interesting in a physiological point of view, for it exhibits
an example of animal engrafting {gr^e animale), by the transplantation of
the cornea.
It is also interesting in a practical point of view, for it has been twice
performed on man.
In addition, keratoplastie experiments present a favourable opportunity,
on the one htmd, to our accustoming ourselves on the eyes of living beings
to ocular operations in general ; and, on the other hand, they enable us to
study, during the course of these experiments, in a very easy manner, a great
number of ^e diseases of the eye, that is to say, inflammation in all its de-
grees and in all its consequences. M. Feldmann then treats of the different
questions connected with keratoplastie, viz. the transplantation, the trans-
parency, the methods, the instruments, and the organic proeess (travail) of
the reunion*
The foUofwiii^ are the remarks of the author on the organic proeess of the
reunion : —
1. The uniofli of the feireign cornea with the eye the suhject of the ope-
ration takes place either by the first <x by the second intention, or by these
two methods at one and the same time.
It takes place by the first intention when the edges of the eomee are in
contact with one another, or when they are only separated from one anotl^er
by a small space. In the second case a very well marked plastic exudation,
furnished by the neighbouring parts, especially by the iris, takes place be-
tween the corneal edges.
It takes place by the second intention when the interval between the
corneal edges is considerable.
2e
218 KERATOPLASTIE.
2. The circiilation (vaseularisation) la established^ in the case of union by
the first intention^ in the new cornea, in the following manner : — One or
several tolerably laige vessels proceed from the bottom (fond) of the con-
junctiva, and advance close to the edge of the foreign cornea ; having arrived
there, these vessels propel the blood into the new cornea by forming in it
new and visible vessels, or by filling the old vessels of the foreign cornea
which had been hitherto invisible. It always happens that these vessels
are at the commencement very minute, mere sanguineous threads (desfileU
ganguins), and they come off from their parent trunk in the form of rays,
or in an arborescent manner. These vessels begin by appearing in the bot-
tom (/and) of the corneal substance, as if the main trunk plunged itself at
first into the deepest part of the tissue to deposit there the first drops of
blood.
3. The transparency of the applied (new) cornea, which remains during
the first days after the operation, disappears aiterwards. The cornea changes
its colour in proportion as the vascukrity is developed in its tissue ; it fin-
ishes in the end by becoming more or less opaque.
4. The aqueous humour wliich had escaped during the operation is repro-
duced very quickly, in such a way as to raise up and cause to project the
cornea, which had remained flaccid in front of the globe of the eye since a
short time after the operation.
5. When a part of the cornea swims, so to speak, in the pus which is
secreted by the exposed (mUes d nu) neighbouring parts, and when at the
same time the eyelids, especially their edges, exercise a slight abnormal
friction on the cornea, it softens, and loses eaidly its conjunctiva. In that
case there is no &rther method by which this cornea, deprived of its con-
junctiva and softened by the pus, can undergo the process of reunion.
6. The comea really transparent, finishes by becoming smaller on account
of the absorption of the half or more of its siuface, and by becoming some-
times flat, at other times convex. The points of cicatrization are adherent
to the ins.—^azette Medicale, Mars 9, 1844.
MATERIA MEDICA AND DIETETICS.
On Skate-Liver Oil,
We abridge some passages of a memoir by Gobley (Journal de Phantiaeie,
Avril 1844) on the skate-liver oil.
1. The skate-liver oil is much less offensive to the sights the taste, and
the smell, than the cod-liver oil. The cod-liver oil is almost always turbid,
brown coloured, and of a disgusting smell and taste ; while the skate-liver
oil is quite transparent, is of a golden yellow colour, and has a weak fishy
smell, and a taste by no means disagreeable.*
2. The skate-liver oil contains more iodine than the cod-liver oil.
3. That the skate-liver oil may be prepared by druggists, and thus that
the doubts arising from the uncertainty of the source of the cod-liver oil of
commerce may be avoided.
Further, M. Gobley thinks, that by his process skate-liver oil may be
* We have seen apedmeni of oil, dedared to be eod-liver oil, fivm ZetUmd, which
agree with this account of the skate-liver oil Mr Pereira states the suggestion of
a dealer, that the pale cod-liver oil of the German druggists must be the Southern
whale-oi]..Mat. Alcd. vol ii. p. 1386L
SKATE-LIVER OIL. 219
prepared at a cheaper rate than cod-liver oil. Skate-lirer oil is commonl/
msAfi by boiling the liyers in water, decanting the oil which collects on the
top, and clarifying it by rest and fresh decantations. M. Gobley's method
is first to remove the membranes from the livers, to slice them thin, and
then to heat them in a vessel (without water, as we interpret his directions),
with constant stirring, until the contents boil ; the boiling is kept up at a
moderate heat until the oil swims on the sur&ce quite detached from the
clots formed by the rest of the substances ; the whole is then thrown on a
piece of flannel, and when the chief part of the oil has passed through, the
remaining mass is pressed against the flannel with a spatula, and left to .
drop for twenty-four hours.
** Oil thus obtained," he says, *^ does not retain water : it is left to itself
for some days to allow it to deposit a certain quantity of white concrete
matter ; when it ceases to deposit this matter, it is passed through filtering
paper and laid by for use. The liver of the skate afibrds more than a
fourth part of its weight of filtered oil."
When a drop of concentrated sulphuric acid is added to fifteen of oil pre-
pared in this manner, a fine violet colour immediately appears, which iSter
a time passes to red. Wlien the oil is prepared by boiling the liver in
water, the colour given by that acid is red from, the first.
M. Gobley goes on to say, that the oil obtained by his process has been
employed in the practice of Professor Trousseau, and that the efiects mani-
fested were at least equal to those afibrded by the brown-coloured cod-liver
oil. Our author thinks it likely that the cod and skate liver oils, besides
iodine, contain phosphorus, which, according to him, would explain their
miraculous efiects in rachitis. He has hitherto fiEiiled to detect it ; but he
is not discouraged, and is resolved to persevere in the investigation.
PATHOLOGY AND PRACTICE OF MEDICINE.
Elephantiasis in Norway.
M. Danielssen, physician to the St George Hospital, Beigen, has trans-
mitted to the Academy of Sciences of Paris a memoir on the Elephantiasis
of the Greeks, which has prevailed epidemically on the coast of Norway for
half a century. This malady seems to rage with great intensity in Nor-
way, for we find that out of 200,000 inhabitants, 1200 were attacked. In
the great majority of dissections which were performed, M. D. found in
the cutis vera, as well as in the subcutaneous cellular tissue, a hard gran-
ular yellowish substance, which appears to have destroyed the tissues in
which it was seated. The same substance was also found in the coats of
the subcutaneous veins, to such an extent as, in the basilic vein for in-
stance, to equal the thickness of the finger. Similar infiltrations were
found in the eyes, the larynx, the trachea, the bronchi, the pleura, the
liver, the spleen, the womb, the intestines, but, strange to say, seldom or
never in the lungs. The treatment is unsatisfactory : once developed, it
usually is fatal.
[This disease, from the description given by M. D., appears to us to be
Elephantiasis Arabum, and not Elephantiasis Griecorum, as he terms it. The
Grecian elephantiasis, lepra taurica or Mai rouge de Cayenne, is in fact the
leprosy of the middle ages, which we find first denominated by Lucretiua
'* Est elephas morbus qui propter flumina Nili." Galen also fixes upon
Alexandria as peculiarly the seat of its ravages (De Art. Curat, ad Glau-
conem, lib. ii.) ; but this is a disease distmct both in its nature and appear-
220 ELEPHANTIASIS IN NORWAY.
ance from the E. Arabum. Arabian elephantiasis never commences primarilj
in the skin, which the Greek elephantiasis always does ; and the latter is now
seldom seen except in natives of the tropics, or those who have lived in
some intertropical country. The results found on dissection by M. D.
correspond with those usually observed in £. Arabum.
Mr Chevalier (Med. Chir. Trans., vol. xi.) found the cellular tissue in-
durated, and the papille of the skin enlarged, thickened, and projecting
from the surface. The epidermis is generally thickened and furrowed ;
the rete mucosum consists of several thickened layers ; the cutis vera
often half an inch thick ; the cellular tissue the seat of a semi-gelatinous
effusion (Andral, Arch. Gen. de Med. 1827 ; ib. 1823). The arteries sup-
plying the afiected part have been found increased (Hendy) ; as was also
the tibial nerve (Naegle) ; and in one case the great sciatic was much en-
lai^d. We have not been able to find the deposition of the morbid matter
in internal organs mentioned by any previous author, and are inclined to
regai'd this as an interesting peculiarity in the cases observed by M. D.]
Case of Ekphanti(u%» Cured by Guaiac and Iodine, By M. Cazenave.
The disease was of eight years' standing ; the limb resembled a solid, hard,
fleshy cblumn.
The patient was ordered a strong decoction of guaiac and mezereon ; the leg
was carefully bandaged fix)m the toes, and every other day the bandages were
removed, and vapour douches applied to the surface, and an ointment of
hydriodate of potass rubbed in. She was put on generous diet and wine,
and confined to bed. The cure was efiected in little more than three months.
This is not the first cure M. C. has met with by this plan, and several other
cases have been benefited. [Mr Bui^ess cured a case by the internal use
of iodide of iron, and the external application of the vapour of sulphur
and iodine.]
Cryptogami of the Hair constituting Herpes Tonsurans (JRingworm),
M. Grubt communicated to the Academy of Sciences a memoir on the
above subject, of which the following is the analysis : —
Among the diseases of the scalp there is one which, by its contagious na-
ture and the obstinacy with which it resists treatment, is deserving of the
attention of the pathologist. It is the tinea tondens of M. Mahon, or the
herpes tonsurans of M. Cazenave.
Tinea tondens is principally a disease of the scalp, and is eharaeterized by
the fidling of the hair in circular patches, covered with onall white scales,
and with slight ineqtialities analogous to what is vulgarly called chicken
flesh. On examining attentively, under the microscope, the fragments of
hair coming from one of these patches, it becomes evident that their entire
tissue is filled with ciyptogami, and that the hairs are still covered with the
epidermic scales when their interior is already fiill of spomles. These
cryptogami originate in the interior of the root of the hair, under the form
of a group of round sporules. As the hair grows^ the cryptogami which it
contains also grow, until it escapes firom its follicle.
The cryptogami which constitute tinea tondens difier so much from those
which contitute phytoalopecia (porrigo decalvans) that these diseases cannot
be confounded. Their seat, their development, and the relation which they
present with the tissue of the hairs, are quite distinct from what occurs in
the latter disease. The cryptogami of tinea tondens are only formed of
DR OLDHAM ON POLYPUS UTERI. 221
sponilesand chaplets ; it is very geldom that we meet with elongated qK>nilefl
imitatiDg branches. The cryptogami of phytoalopecia, on the contrary,
present numeroos branches, curved, nndulated, the sporules being placed oti
the side. In tinea tonsurans the sporules are large (diameter equal to 2 to
6-lOOOth of a millimetre). The sporules of the cryptogami of phytoalopecia,
on the contrary, are very small ; their diameter is only 1 to 5-1 000th of a
millimetre. In tinea tonsurans the sporules fill the interior of the hairs,
whilst their external surface is but slightly altered. On the contrary, the
sporules of the mtcrosporon Oduini are placed on the external surface of
the hairs, and form quite a sheath around them. Th« ciyptogami of tinea
tonsurans originate and develop themselves in the root of the hairs. The
microsporon Oduini, on the contrary, develop themselves on the external
sur&ce of the hairs, outside of the follicles. These characters are so invari-
able in tinea tonsurans that there is not a single diseased liair which does
not present them.
MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN.
Dr Oldham on Polypus Uteri arid iU Coexistence toith Pregnancy.
Dr Oldham's communication on Polypi* is one of far greater importance
than the author's fanciful and novel definition led us at first to consider it.
Although we cannot but commend the industry displayed by Dr Oldham
in examining the structure of these growths, yet, as our main object is to
furnish our readers with valuable practical information, we shall merely
enumerate, very briefly, his remarks regarding their.situation and anatomi-
cal character. The^r*^ variety is described as a fibrous, pediculated tumour,
of frequent occurrence, assuming all shapes and sizes, originating from all
the regions of the uterus, but most frequently from its fundus, body, or
sides ; sometimes covered by the deeper tissues of the organ, at other times
merely by its mucous membrane ; their vascularity residing essentially in
their uterine covering, the arteries being insignificant compared to the
great size of the veins, which do not appear, from the result of injections,
to enter into the growth, though the arteries seem to do so freely ; they are
tardy in their descent or in acquiring a pedicle ; may destroy the patient by
hemorrhage, or by a clear watery discharge so copious as to saturate two sheets
in the course of twenty-four hours, as happened in a case described by the
author. Dr 0. informs us, that the uterus, not from its own weight, as was
at one time supposed, but rather in consequence of its action to force down
its contents, becomes partially inverted, which should be remembered in
noosing the polypus, lest the ligature might be applied too near its radix
and include the uterine tissue, which might, and we suspect often has, led
to fatal results. The writer concurs in the views of the late M. Dupuytren,
who maintained that a polypus which had lain long in the vagina had a
tendency to undergo a cancerous degeneration, in some instances by a
transformation of the growth into a cerebriform matter, and in others by the
generation, as in this case, of fungoid patches, with softening of their struc-
ture. In support of these latter sentiments, Dr Oldham adds the particu-
lars of a case which occurred about two years ago in St Bartholomew's
Hospital. Here an excrescence, the size of an orange, was noosed and
tightened without pain ; but during the night straining efforts supervened,
and forced into the vagina a mass of the magnitude of a calf's heart, on
which a ligature was also placed and tightened every twelve hours. On
• Guy's Hospital Reports, April 1844.
222 DR OLDHAM OX POLYPUS UTERr.
the second or third day alter this step, profase hemorrhage, owing to the
rupture of a laige vein, commenced, which ultimately required the bleed-
ing vessel to be secured. Rapid decomposition now followed, attended by
an effluvium so offensive as to require the removal of portions of the mass
by the knife and the use of the chloride of lime. The remainder of the
polypus was detached on the fourteenth day, and the patient had a com-
plete recovery. The malignant conversion insisted on by the late M.
Dupuytren, and acquiesced in by Dr Oldham, does not invariably happen,
for we have seen two polypi of immense size, which had for several years
been lodged in the vagina without undei^ing the change referred to.
The second vaHety of polypus described, is what has been styled spongy,
cellular, or fibro-cellular : it may grow from any part of the womb ; it is
softer and more impressible at the commencement than the variety already
described. Sometimes, instead of descending to the os uteri, it ascends towards
the fundus of the organ. On examining its structure, void spaces or cells
are displayed, which the writer considers as truncated and divided veins.
The present differs also from the foregoing variety in as far as that the
veins are freely distributed throughout its substance. When associated by
pregnancy, it may acquire so large a size as to weigh several pounds. Several
illustrative examples are added, to which we shall presently advert.
A third variety of polypus particularized, is one composed of a number of
little cells, the size of the Graafian vesicle, with thin walls, filled with a
pellucid fluid, supported by a fibrous tissue, about the size of a Brazil-nut,
growing from the body of the terns, and furnished with a short pedicle.
A fourth variety is furnished by an enlargement of the crypts of the
cervix uteri ; they are sometimes several in number, vascular, filled with
a curdy fluid, covered with a cortical layer of fibrous tissue, and about the
size of a walnut.
Dr Oldham describes a fifth variety not previously particularized. It
arises from the cervix uteri, and from its interior exhibiting numerous large
channels, he styles it channelled polypus of the cervix. The hemorrhage
attendant on these growths is satisfactorily proved by the writer to arise,
not from the uterine vessels, but from the veins of the excrescence, or of
those of its investing mucous membrane.
In the latter part of this communication, which is highly interesting, the
writer informs us tliat the presence of a polypus will not prevent pregnancy,
a fact with which we presume the profession have long been familiar ; and
in corroboration of which a number of most important cases are added.
Hera Dr Oldham suggests the very necessary precaution, before interfering
with small polypi of the os and cervix, of ascertaining whether or not the
patient be pr^nant, a state which might not be suspected, owing to the
presence of disease and the occasional occurrence of hemorrhage ; and an
illustration is related exactly in point, where the application of a ligature
to a small polypus, in a patient w:ho did not consider herself pregnant, in
consequence of a sanguineous effusion sometimes appearing, very speedily
afterwards expelled an ovum. Of the cases by which this portion of the
communication is illustrated, five have not previously been published ; and
of these, with the diagnosis and practice, we shall now give a summaiy.
In the/rtTof these, that talented and active practitioner, Dr F. H. Bams-
botham, was consulted three weeks after delivery by Mr Moon : there were
ineguW discharges of blood, the uterus was tender, as large as if sis
mmiks preynaHt^ its aperture could only receive one finger, by which a
body resembling a coagulum or a second foetus was felt. Ergot in large
quantity was exhibited, whicb caused much pain daring the n^fat. Next
I
DR OLDHAM ON POLYPUS UTERI. 223
day Mr Mood, being hurriedly called, feeling the os uteri opened and some-
thing protruding, he passed his hand without much trouble into the uterus
by the side of a tumour which was furnished with a stem that was im-
planted into the fundus. This stem was firmly embi-aced ; and under strong
uterine action, the hand, with a fibro-cellular tumour the size of an ostrich-
®Rg» were expelled together ; and the patient recovered without an unfa-
vourable symptom. The second case was communicated by Dr Radford^ of
Manchester, who was consulted a fortnight after delivery. The patient,
when he was called, was in articuh mortiSy and died two or three hours
afterwards. She had frequent sanguineous discharges, violent paroxysms
of uterine pains, and straining efforts, and the uterus felt larger than it ought
to be. On dissection^ the uterus was found to contain a polypus about two
inches in length, and varying from two inches to one and a half inch in
circumference, growing from the fore part of the body. The third case Dr
Radford saw the day after her delivery. She had hemorrhage, frequent
small pulse, violent straining, and an enlarged state of the uterus. The
hand was introduced into the uterus, a polypus the size of a pear noosed,
the ligature daily tightened, and the excrescence detached on the eighth
day. Dr Radford saw the fourth case six hours after delivery ; found her
with a profuse dischaige, bearing-down pains, and unusual enlargement of
the uterus. While preparing to apply a ligature, a severe uterine con*
traction supervened, which detached and forced into the vagina a growth
equalling iJie size of a moderately large orange. To case fifth Dr Radford
was called soon after delivery. The symptoms already particularized in
the other cases were here also complained of. On examination per vaginam
a tumour the size of a foetal head of the seventh month was felt above the 08
uteri. The placenta was still retained. The hand was introduced ; the
tumour, which had but a small stem, separated by torsion, and, with the
placenta, removed ; and the patient eventually recovered.
It follows that the diagnosis in the foregoing important cases consists in
an unusual enlargement of the uterus, occasional discharges of blood from
the vagina, uterine pains, severe straining, and, on examination per vaginam,
a foreign body being felt above the os uteri. By these cases it is also esta-
blished that the presence of a polypus, whether growing in the interior or
&om the OS or cervix of the organ, will not prevent impregnation ; that the
hemorrhage, whether in the unimpregnated state or after parturition, arises,
not from the uterine vessels, but from those of the excrescence ; and that,
with safety to the patient, the growth may be removed by torsion or liga-
ture, and sometimes by the contractions of the uterus alone.
FORENSIC MEDICINE AND MEDICAL POLICE.
Iodine a Preservative against Variola.
Dk Schreibeb states, that he has found the administration of iodine useful
in preventing the members of the fiunily of a person labouring under small-
pox from being infected with the same disease. The formula he used was
as follows : —
R. Hydriod. potass. . . . gr. viij.
Tinct. iod. . . . g*** xvi.
Aque font. .... 5 U*
S. A teaspoonful morning and evening. Dr S. invites practitioners to a
further inyestigaiion of the powers of iodine in this respect. — Henk^s
Zeitsdinft, No. IV^ 1843,
224 MEDICAL MEMORANDA.
Part IV.— MEDICAL MEMORANDA.
How far is a Prisoner accused of Murder Jield guiltless provided the Deceated
has a Surgical Operation performed upon him f
" Should an operation be unnecessarily and unskilfully performed, the re-
sponsibility of an aggressor would of course cease, if the death of a wounded
party could be clearly ascribed to it. Thus, if in carelessly bleeding a
wounded person, the brachial artery should be laid open, or if, in performing
amputation, a large artery be imperfectly secured, so that the patient in
either case die from hemorrhage, the prisoner is not responsible ; because
it would be punishing him for an event depending on the unskilfulness of
the medical practitioner. But supposing the bleeding or amputation to be
performed with every proper care and skill, and yet, in the one case,
phlebitis, and in the other tetanus, gangrene, or fever should destroy life,
the prisoner will be differently situated.
** The practice of the law is strictly consistent with justice. If the opera-
tion be absolutely required for the treatment of a wound, — ^if it be performed
with ordinary skill, and still' death ensue as a direct or indirect consequence,
the prisoner will be held responsible for the result. It is presumed in these
cases, that if the patient were left to himself he would, in all probability,
die from the effects of the wound. If, therefore, a sui^geon, knowing that
an operation would give a chance of saving life on such an occasion, did not
perform it, it might be successfully contended in the defence, that the de-
ceased had died, not from the ivound, but from the incompetency and neglect
of his medical attendant. Hence it follows, that if, during this very neces-
sary treatment, unforeseen though not unusual causes cut short life, no
exculpation should be admissible, if it went to attack the best directed
efforts made for the preservation of life.
^* By an operation being absolutely required, we are to understand that it
is necessary to preserve life. Bleeding and cupping may be necessary in the
treatment of a wounded person ; but unless it could be sworn that this
treatment was required for the preservation of life, it is doubtful whether,
in the event of death occurring from these simple operations, the assailant
would be held responsible for the fatal result.
*' In 18279 two persons were tried in Edinbui^h for capitally assaulting
another by throwing sulphuric acid over him. The death of the deceased
was clearly due to phlebitis and conc<»nitant fever, following the operation
of venesection, which was considered necessary in the treatment of the case.
It did not appear that this bleeding was absolutely necessary for the preser-
vation of life, but merely for the prevention of severe ophthalmia. The
charge of murder was therefore abandoned : — ^this question of responsibility
for the &tal result being considered to involve too nice a point to ensare
conviction." — Taylor.
ERRATUM IN LAST NUMBER.
Page 131, end of third paragraph,/or aq. fontis, 3xii,, read aq. fontis, ^xii.
I^intcd by Oliver & Boyd, Twooddate Court, High Sircet, Bdinbiirsb.
THE
NORTHERN
JOURNAL OF MEDICINE.
No. IV.— AUGUST 1844.
Part I.— ORIGINAL ARTICLES.
Observations on the Best Mode of Registering Deatlia, Read at
an Evening Meeting of the Royal College of Physicians, June
1843. By William Pulteney Alison, M.D., F.R.S.E.,
Professor of the Practice of Medicine in the tlniversity of
Edinburgh, and one of the Physicians in Ordinary to her
Majesty for Scotland.
The subject of Registration of Deaths with a view to facilitating
statistical inquiries into the history, causes, and prevention of
diseases, has been pretty fully considered and reported on by a
committee of this college ; and I think every one who has ex-
perienced the difficulty of extracting satisfactory information from
the Registers now existing, must admit its importance. A decided
opinion was expressed by that committee, that the method adopted
by the medical advisers of the Registrar-General in England, and
according to which the deaths there occurring are arranged and
classified, although a great improvement on the old bills of mortality ,
is liable to very serious objections. The objections which we
stated have been considered at some length by Mr Farr, in a
paper contained in the Fourth Annual Report of the Registrar-
General of England ; and the members of this college may be
somewhat disappointed at perceiving that, although expressing
himself in complimentary terms towards us, he declines adopting
any of our suggestions, and gives a decided opinion that his plan
of registration is much superior to ours in almost every respect.
As I am by no means convinced by his reasoning, I wish to
lay before the college the reasons which still lead me to think
that the plan which we proposed is decidedly preferable, and
that if a registration bill for Scotland shall be brought forward,
we ought to endeavour to have the registration of deaths under
it conducted according to our plan rather than according to that
which is now adoptea in England.
We must bear in mind that, in a scientific view of the subject,
the main objects of such registrations are —
2 F
226
ON REGISTERING DEATHS.
1^^, To secure the greatest amount of authentic information as
to the causes of death.
2dlVf To separate distinctly that information which must ne-
cessarily be only general, from that which may be expected to be
minute and precise ; and,
Sdly, To facilitate the labours of future statistical inquirers
who may wish to have various portions of this informatioQ
thrown into the form of tables.
The objections which we stated to the English plan related,
1st, to the form of the schedule according to which the deaths
are registered ; 2dly, to the nomenclature of diseases, to which
all practitioners are requested to conform.
1. The essential difference between our schedule and theirs is,
that we wish to have that part of the Register appropriated to
the cause of deaths, divided into two columns — one to be filled
up in every case without exception, but which is to contain, not
the name of the disease (unless in the case of well-known epi-
demics) but only the seat of the disease, and its nature as acute
or chronic ; the other column to give the name of the disease,
always on medical authority, and only when well ascertained.
This column will be filled, of course, in a much smaller number
of cases, but will always give precise and accurate information,
in conformity to printed directions to be put into the hands of all
practitioners. We suggested, also, that each column should be
subdivided into two, — -the first stating what diseases are acute and
what chronic ; the second stating what disease caused death, and
what (if any) previously existed.
On the other hand, in the English registers only one column
is assigned for the cause of death ; and Mr Farr thinks it pre-
ferable to have all the particulars stated in this single column.
The following sketch shows the difference of the two plans : —
Plan recommended by the Edinburgh
Committee,
; Improved English Plan.
Dumtion and Seat of *, ^^.
Disease. Name of Disease.
Cause of Death.
Acute,
Bowels.
Chronic.
Causing
Death.
Previously eHst-
ing Disease, or
cause.
—
Dysentery.
—
Dysentery, 20 days.
—
Chest.
Consump.
tion.
—
Consumption, 1 year.
Chest
—
Pleurisy.
Epidem. fever.
Typhus, 17 days.
Pleurisy, 2 days (p. mort.)
Our reasons for preferring the plurality of columns are these :
1*^, We consider it quite certain that, as to a large proportion
ON REGISTERING DEATHS. 227
of the deaths, there will be no report by a medical man, on
which reliance can be placed ; the cases either having been
seen by none, or seen so cursorily, or at so advanced a period,
as to make it impossible for them to pronounce confidently on
their exact nature. This, I think, all practitioners will admit to
be true, even of many cases of which they could say, with a good
deal of confidence, whether any and what remedies were l^ely
to be of service ; and if so, it is obvious that to require or
even to invite a declaration of the cause of death, in the same
mode, in all cases whatever, is to make the statistical statements
to be founded on those registers an almost certain source of
fallacy, and of erroneous doctrine.
- This is substantially admitted by Mr Farr himself, for he
says that in England the names of diseases have often been
returned, particularly as to cases not seen by medical men, in a
very unscUisfactory manner ; but the remedy which he suggests
is, to have all such cases inquired into after death by medical
men, and then named ; which, as it appears to me, is not a
procedure that can be adopted, at least in Scotland, with any
prospect of more satisfactory results.
But, on the other hand, it is equally certain that there are
various particulars which are easily ascertained, in regard to all
cases without exception, and which of themselves, if ascertained
uniformly and universally, will give results of great importance.
These are, not only the age, sex, precise locaUty, and condition or
mode of life of the deceased, but likewise the auration of his dis-
ease, as acute or chronic ; in the case of well-known epidemics, the
name may be safely assigned, and in all cases of sporadic diseases,
the part of the body in which the chief symptoms appeared.
The importance of having these particulars recorded as to
all cases, combined with the impossibility of having a scientific
statement of the cause of death in many, forms the difficulty
which we propose to surmount by the two distinct and even
subdivided columns.
It is no doubt possible to record all the particulars that we
wish in a single column, and to have the names of diseases only
assigned in that column when it can be done accurately, and
afterwards to pick out, from the entries there, the cases which
are accurately named, as distinguished from those of which we
know only the seat and duration. But let us observe the in-
conveniences of this mode of proceeding.
1st, There is much greater trouble m throwing the informa-
tion required into the form of tables. For example, if we
wish to know how many acute and how many chronic diseases
of the head are recorded in a given register and within a given
time, how many of these have been registered in general terms
only, and how many accurately named, we should have the trouble
of seeking out and reflecting on the import of a great number of in-
dividual words, instead of merely summing up a column of figures.
228 ON REGISTERING DEATHS.
2dly, By having only one column, in which all the particn*
lars regarding the cause of death are to be stated, the attention
of those making up the registers, whether medical men or not,
is not fixed on the different particulars in regard to fatal disease
which demand separate consideration, and there is a much
greater chance of careless and fallacious registration.
ScUy, No distinct line of demarcation is drawn between
cases carefully observed and recorded by medical men, and
cases the real nature of which may be quite unknown.
I admit that there is some force in the objection stated by
Mr Farr to our division of acute and chronic diseases, accord-
ing as they are of less or more than six weeks' duration ; viz.
that you might as well divide all people into yoimg and old,
according as they are a,bove or below the age of twenty. But
still it appears to me, that the chief practiced use which can be
made of the entries of the duration of diseases, in Mr Farr's
own column, will be to make up tables of diseases of different
parts of the body and in different times and places, as acute
or chronic, and I do not know a better line of distinction
between acute and chronic diseases than that which we have
stated. The formation of such tables will of course be ex-
tremely facihtated by having these separate columns ; and
then, as the precise duration may be stated in each individual
case in one or other of those columns, the more precise informa-
tion which he considers essential may be obtained from our
register equally as from his.
But the objections which he states to our having a column for
the seat of disease, as distinguished from the name, proceed on
an entire misapprehension. He says that nobody who is to use
the registers will require to be informed that c(msumption is a
disease of the lungs, and so forth ; — not observing that our rea-
son for wishing the latter fact to be stated in all cases is, that we
are sure it can be accurately stated in many, in which the dis-
ease, cannot be named, or will be named incorrectly ; therefore,
that by this column we gain a piece of authentic and important
information, extending to a much larger number of cases than
the named diseases. But we have the names given as distinctly
as he has, in all those cases in which that information can be given
on proper authority, and is therefore of real value.
That he has misapprehended the practical working of our plan
appears distinctly from his criticism on it, at p. 215 (of Fourth
Annual Report) : " The Edinburgh Committee have assumed
that distinct diseases, which cannot be distinguished in all cases
and by all practitioners, should invariably be confounded under
the same entry in 'the register. For instance, because it is pro-
bable that C and D would often confound croup, quinsy, and
laryngitis, they would direct A and B and all well-informed
practitioners to return the three diseases to the registers as ' acute
disease of the windpipe.' What would be the consequence of a
ON REGISTERING DEATHS. 229
reeommendatioii of ibis kind ? If the cases of croup, laryngitis,
and quinsy are stated separately, it will be an easy matter to
add ^em together ; but if the three diseases be confounded sys-
tematically m all the registers, they can neyer afterwards be
analyzed. According to Dr Alison's plan, all the physicians and
surgeons of the country, whatever might be their sluU in diag-
nosis, whatever be the progress of medical science, would be
bound to assign the cause of death in general terms, instead of
the precise terms by which diseases are generally designated."
Now, according to our plan, every physician and surgeon will
be at hberty to exercise his skill in diagnosis to the utmost, be-
cause he will be (zsked to give a name to every case which he
has seen (although a shorter and simpler nosology than that of
Mr Farr will be recommended to him) ; but it Can be no great
trouble to him, besides giving the name, or when he is uncertain as
to the precise name, to enter the disease in our first column as one
of the head, chest, or abdomen ; and by doing so he will enable any
future inquirer easily to enter the case in two distinct lists, both
equally authentic, the one containing certain particulars only, the
other, a shorter list, containing more minute information.
It is to be observed, that in all Mr Farr's lists there are a
number of cases recorded merely as disease of the head, disease
of the lungs, Sfc, which is an admission of our principle, that the
seats of diseases can be stated in a number of cases where the
names cannot be assigned. But these cases, from the deficiency
of his plan, are not stated as acute or chronic ; and their number
is so small in comparison to those where the disease is named, as
to show very distinctly, that on the names assigned to many of
these cases little reliance can be placed as a scientific record.
I think I have shown that the plan of two columns with sub-
divisions, — although a little more troublesome to the framers of
the schedules, — ^will be in fact less troublesome to the recorders
of deaths, than Mr Farr*s plan of crowding so many particulars
into single columns, while it will give great facilities to future
sdentific inquirers.
There is a suggestion contained in Mr Chadwick's Report
upon the sanitary condition of the labouring classes, which shows
very distinctly the importance of having authentic records, not
only of the diseases causing deaths, but of the circumstances
attending and causing diseases, viz., that in addition or as supe-
rior to the medical officers in charge of districts (that is, of unions
under the amended Enghsh poor-law) there should be a small
number of superintendent medical officers charged with all
inquiries affecting the public health, and that one of their duties
should be the examination of the registers, to ascertain whether
any particular diseases prevail at particular times in individual
districts or classes of the community in an unusual degree, and
if so, whether these can be traced to removable causes. It is
obvious how much the labours of such men would be facilitated
230 * ON REGISTERING DEATHS.
by such a form of the registration of deaths as we recommend,
with one simple addition, that our last column should comprise,
as suggested above, not only any previously existing disease, but
cause of disease.*
Of the faciUty of registers being kept in the way we propose, we
have fortunately an example in the parish of South Leith, where,
under the direction of Mr Lyon, the session-clerk, the register
has been kept for some time past almost precisely on that plan.
II. On the hst of diseases adopted in the English returns, as
compared with the much shorter list recommended by the com-
mittee of this college, I do not think it necessary to enlarge, be-
ing quite content to leave it to the judgment of the profession,
whether it be expedient, or likely to lead to useful results, to
invite all practitioners to enter on the minute and sometimes am-
biguous distinctions in giving the names of diseases which the
English lists require. But there is an unfortunate difference of
opinion between Mr Farr and our committee in regard to the great
leading division (of the importance of which we are all agreed), —
that 01 plagues, or epidemic and endemic diseases, occurring only
within certain limits of time and space, and the sporadic diseases, of
more uniform occurrence, — which demands a little consideration.
Mr Farr*s principle is, that if any disease, or if cases which
assume the characters of any disease, and are not easily distin-
guished from it, become epidemic at greater or less intervals of
time, — even although it be only in what he calls unhealthy places
and among the sickly classes, — ^that disease must be ranked
among the plagues, and all cases of it, in all seasons, and how-
ever isolated they may appear, must be set down in the great
division of epidemic and endemic diseases. Any other plan, he
says, would lead to endless confusion.
Hence he sets down every year all cases of croup, of aphthsB, of
dysentery, cholera and diarrhoea, and erysipelas, among the epi-
demic, endemic, and contagious diseases. He is strongly impressed
indeed with the importlince of distinguishing croup, which he thinks
an epidemic disease, from laryngitis and from quinsy, which he
ranks among the sporadic (wmch distinction I apprehend to be a
difficult matter) ; but thinks that all the cases of cholera now oe-
currin^ must be classed with mali^ant or Asiatic cholera, and that
it is quite as unreasonable to distinguish them, as to separate mild
from malignant scarlatina; whereas I believe that we in Edinburgh
will generally maintain, not only that in a great majority of cases
even fatal sporadic cholera is easily distinguished from the ma-
lignant, but that they are essentially and pathologically dis-
tinct diseases, and that the true malignant cholera was never seen
in Scotland before 1831, and has not been seen since 1833.
In regard to several of the diseases in question — dysentery,
erysipelas, croup, or even diarrhoea — ^we must allow that occasions
do occur when they prevail epidemically or endemicaUy, although
* Chadwick*s Sanitary Report, p. d52.
ON REGISTERING DEATHS. . 231
not to be distinguished by their symptoms from the sporadic
and often isolated cases, which may often be distinctly traced to
cold» to repletion, or other causes of continual occurrence. But
I cannot think it right, — on the contrary, I think it must tend
to endless confusion, — ^to rank, on that account, all cases of these
diseases among plagues or epidemics.
The reason of making a distinct class of epidemics, and lay-
ing stress on their distinction from other diseases in statistical
inquiries, is, that the study of their history, causes, and means
of prevention, is essentially distinct from the study of the same
particulars in regard to the sporadic diseases ; but this reason
exists no longer, when we find that all cases, however isolated,
of croup, aphthsa, diarrhoea, or cholera, are ranked among the
epidemics, with smallpox and measles. Nobody can suppose that
the means of prevention, applicable to ordinary cases of any of these
diseases,haveany analogy to the means by which we strive to arrest
the extension of malignant cholera, or of plague, and with a view
to which we study the histories of the diffusion of these diseases.
The only way, as it seems to me, of avoiding such difficulties,
or even absurdities, is that which we formerly suggested. Let
each of those diseases, when it occurs, as usual, in isolated cases,
be entered among the sporadic diseases ; but when any prac-
titioner meets with such cases occurring so frequently, within
narrow limits of time or space, as to indicate, m his opinion,
the existence of a local and temporary cause, let him be re-
quested to prefix the term epidemic, and those cases may then be
ranked in the tables along with the epidemic diseases. And
although there may occasionally be a difference of opinion as io
whether the term epidemic is rightly applied, yet as in every such
case the number of deaths attributed to such epidemic influence
in any locaUty will appear, it will always be in the power of
any one who uses the register to form a judgment on the point,
whether the term is truly applicable.
I have the less difficulty in recommending this, as it is exactly
what is done (and the principle of doing it therefore tacitly admit-
ted) in the Eriglish tables as to two remarkable diseases. Mr Farr
has bronchitis among the sporadic diseases, and influenza among
the epidemics, I think quite correctly. But influenza may be
very reasonably called an epidemic bronchitis, and certainly
it is at least as difficult to distinguish it from many sporadic
cases of catarrhus senilis, as to mstinguish malignant cholera
from the common cholera of this country, proceeding from an
increased flow of bile.
Again, Mr Farr has among sporadic diseases what he calls gas-
tro-enteritis, and explains as being inflammation of the mucous
membrane of the bowels ; but we all know that this inflamma-
tion occurs frequently and epidemically in connexion with
typhoid fever; and that it is still disputed, whether there is
not an epidemic typhoid fever, distinct from the true typhus.
232 ON REGISTERING DEATHS.
and attended uniformly with this kind of inflammation. Such
complex cases, if they have any distinctive name in the English
tables, must, I presume, be called epidemic gafltro-enteritis, as
distinguished from the sporadic cases of that inflanunation. This is
another example where he must rank some cases of a disease as
sporadic, and others, occurring in certain times and places, as
epidemic. We have only to extend the practice, which I think
he must adopt in regard to these two diseases (if he is to embody
in his tables the information which they certamly ought to give
in regard to them) to other cases, in order to have a complete
justification of the mode of proceeding recommended by us.
For these reasons, I must be permitted to express the hope,
that if we shall have the satisfaction of seeing a registration
act introduced into Scotland, any influence which this college
may possess will be exerted to secure, that the parts of the
registers appropriated to the causes of death may be kept in the
way that our committee has recommended, in preference to that
which has been adopted in England.
Note. — Form of Queries by whkh the Register isfiUed up in South Leith.
No.
Name of deceased ... ... ...
(StaU the Maidm at wU at Married Nam qf ~
Femafet.)
Sex
Condition, as Single or Married, or
Widowed
Age, last birth.daj ... ..._
Relationship to, if not Head of Family,
and Employment, if any ... ..._
Head of Family and his Employment _
Exact place of ordinary residence .. _
{Slate the Street, No, qf ditto or kmd,)
Date of Death, and place of it, if not
the same as ordinary Residence
Date of Burial
Place of Interment
Medical A ttendant,
Or if none, the Disease, if distinctly
known, seat of it, and duration
(Signed) Undertaker.
Nois.— R it rejwtted (kat the Medieed Attendant ituerttkeSdeia^ntmenftkeJHeeate.
Seat of Disease
Duration of do.
Disease causing Death
Disease previously existing, if any . . . ._
(Signed) __Med. Atf»
ENLARGEMENT OF THE HEART. 233
On the Diagnosis and Treatment of Enlargement of the Heart,
connected with Incompetency of the Aortic Valves. By
William Henderson, M. D., Professor of Medicine and
General Pathology in the University of Edinburgh.
In the first number of this journal I published a short
])aper on the employment and action of digitalis in certain
diseases of the heart, and noticed incidentally the speculative
grounds on which it appeared to me that the characteristic
effect of digitalis on the frequency of the heart's action, though
eminently serviceable in some diseases of the heart, was calculated
to be injurious in a certain affection of the organ ; and I signified
my intention of adverting on a future occasion to other expe-
dients, common in the ordinary treatment of organic diseases of
the heart, which are improper in that of the particular disorder
to which I allude. In reference to this disease, it was stated, —
" Patency of the aortic opening, at that period when the
ventricles are being filled, necessarily admits of regurgitation
from the aorta, the effects of which are an overloading of the
left ventricle, and gradually an enlargement of it — an enlarge-
ment so great ultimately, if the patient survive long, as to ex-
ceed, often to a great extent, that which occurs under any other
circumstances. • * * Such being the tendency and issue
of that overloaded condition of the organ which results from re-
gurgitation from the aorta, it will be granted that whatever
increases the amount of the regurgitation must accelerate the
progress of the enlargement. That the less frequently the
heart beats, the greater will be the opportunity for this re-
gurgitation, is sufficiently obvious ; and hence it is, that the pro-
longed action of digitalis cannot but be injurious when the aortic
valves are not competent for their office." If it be not in
consequence of the regurgitation that the ventricle becomes
enlarged, of course it cannot be by rendering the regurgitation
more considerable that digitalis can contribute to the progress
of the enlargement ; but if the regurgitation do operate in the
manner supposed, it will not be difficult to admit, that the
greater the amount of it, the more rapid will be the increase of
the enlargement — ^that, in short, the effect will bear a proportion
to the cause. I apprehend that no doubt can be entertained of
the manner in wliich the enlargement is effected, — that it is
actually due to the reflux of blood from the aorta, as a con-
tinued and habitual cause of over-distention of the ventricle ; and
I do not conceive it necessary to adduce any facts or arguments
in support of the statement. At the same time, it is not main-
tained that the regurgitation acts, in producing the enlargement,
merely in the way of mechanically distending the left ventricle ;
on the contrary, it is doubtless true that the increased exertion
2g
234 ENLARGEMENT OF THE HEART.
on the part of the organ at every pulsation, rendered necessary
by the greater amount of blood it has to expel and sustain,
and the greater frequency with which it almost always pulsates
in this disease, contribute to induce that increased nutrition
which is characteristic of muscular tissue, the contractions of
which are for a length of time more powerful and more frequent
than usual.
Assuming, then, that the regurgitation is the cause of the
enlargement of the heart, it becomes a matter of much practical
importance to reflect on the consequences which may result from
the use of means by which the regurgitation may be increased.
I adverted in ray former paper to the experience of Dr Corrigan
in reference to digitalis, and remarked that my observation con-
curred with his as to the less satisfactory operation of that medi-
cine in general, in cases of incompetency of the aortic valves,
compared with its effects in most of the other diseases of the
heart. The allusion which I made to the manner in which the
digitalis may be understood to act so differently in the disease
in question from what it does in the others, is quite in accordance
wiUi Dr Corrigan's explanation of the circumstance as expressed
in the following quotation : — " If the action of the heart be ren-
dered very slow, the pause after each contraction will be long,
and consequently the regurgitation of blood must be consider-
able. Frequent action oi the heart, on the contrary, makes the
pause after each contraction short ; and in proportion as the
pauses are shortened the regurgitation must be lessened."*
Again, " To retard in such circumstances the action of the
heart would be to do an injury. In every case of this disease,
in which digitalis has been administered, it has invariably aggra-
vated the patient*s sufferings. The oppression has become
greater, the action of the heart more laboured ; the pulse
intermittent, and very often dicrotic, from the heart being
imable by a single contraction to empty itself; general conges-
tion and dropsy, if present, have been mcreased, and in some of
the instances bronchitis from congestion has been induced ; the
respiration more laborious, and the strength so much sunk, that
patients seemed almost moribund. From this state they only
recovered by omitting the digitalis, and putting them on stimu-
lants."t
These observations of Dr Corrigan have been for twelve years
accessible to the profession, yet I do not remember to have heard
them once acknowledged as' just, while I have often witnessed
the adoption of the practice which he condemns. Since I per-
used his paper seveml yeai-s ago, and had learnt how to distin-
guish the disease of which it trcjits, I have not had recourse to
the protracted employment of digitahs in the treatment of it ;
* £ilinborgh Mediral and Surgical Jourua), voL xxxvii. p. 242. t Ibid.
ENLAUGBMENT OF THE HEART. 235
but from what I haye noticed of its lengthened employment by
others, I have no doubt of the accuracy of his doctrme as a gen-
eral fact. I cannot say, however, that my experience goes to
the extent stated by him in the following sentence : — " In no
case of this disease did digitalis produce the slightest good effect ;
and in all, the patients, while under its exhibition, were always
worse." On the contrary, I have not unfrequently remarked
considerable relief to result from its employment in cases in which
the disease appeared to have been of no very long standing, op
to have entailed comparatively little dilatation of the left ven-
tricle, and to have produced but an inconsiderable impression
on the general health. In several persons affected with the dis-
ease, yet still robust or plethoric, digitalis, aided by a moderate
blood-letting even, I have known to produce verjr striking reUef
to oppression at the chest and difficulty in breathing ; and I can
account for the strong terms in which L)r Corrigan expresses the
very different results of his experience, only by supposing that his
cases were all in an advanced stage when the digitalis was ad-
ministered. Yet I must add, that even in an advanced stage of
the disease I have not found that " the patients while under its
exhibition were always worse ;" for it has pretty often happened
that the medicine, though continued for a considerable time, had
no effect on the frequency of the pulsations of the heart, and
was unattended by any change in the symptoms.
What I particularly desire to solicit attention to, is the general
impropriety of the ordinary practice in diseases of the heart, —
repeated evacuations of blood, frequent and prolonged employ-
ment of digitalis, and scanty nourishment — ^in incompetency of
the aortic valves ; and as an example of the evils which result
from it, I extract the following paragraph from Dr Corrigan 's
paper : — " One case may be mentioned, out of many that oc-
curred, showing the bad effects of debilitating treatment on the
disease before us, and exemplifying the evil of acting as if one
Erinciple were sufficient for guiding us in the treatment of all
eart diseases. The treatment ordered was in accordance with
that generally recommended, consisting of repeated small bleed-
ings, blistering, the exhibition of digitalis, and the most rigid
regulation of diet, a total abstinence from animal food, and even
a spare allowance of vegetables and milk. At the time the
patient, a young man, was put under this treatment, he was not
in an alarming state ; but the disease being recognised as heart
disease, he had the fortitude to submit to a course which he was
led to expect held out a prospect of cure. Bleeding after
bleeding and blister after blister were repeated, starvation en-
forced, and digitalis exhibited, until the patient was reduced to
such weakness, that he had scarcely strength to raise himself in
bed. The local disease was all this time, however, growing
worse ; for the palpitation, cough, &c., were, from the slightest
236 ENLARGEMENT OF THE HEART.
cause, increased to a greater violence than previously to the com-
mencement of the treatment. The plan was, nevertheless, per-
severed in, until the patient's death being supposed at hand,
this debilitating treatment was discontinued. From that hour
the patient got better ; and as his muscular strength returned,
the embarrassment of breathing, palpitation, cough, &c., became
less and less urgent. The patient is still alive, the disease is
still present ; but with full living and good air he is able not
only to take considerable exercise, but even to undergo the
fatigue of a business that constantly requires very laborious
exertion." (P. 241). I can adduce no example so fully illustrative
of the truth and importance of the practical views promulgated
by Dr Corrigan. I have, however, witnessed some cases in
which the depleting and reducing plan had aggravated the suf-
ferings, and others in which good diet and exertion, not carried
to an extreme, had been felt the best adapted to the comfort and
ease of the patients. One instance I remember of a porter,
affected for a long time with this disorder, who continued for
years fit for liis laborious occupation, indulging repeatedly duriug .
the day in potations of malt liquor ; and whether we credit bis
account or not, that he felt them necessary to the freedom of
his breathing, &c., I was satisfied that, under the exciting in-
fluence of them, he exhibited no evidence of that suflFering which
could not fail to have been produced in any other kind of
diseased heart, equally considerable, by the same habits.
In alluding to the diagnosis of this condition of the aortic
valves in my former paper, I observed that it was perhaps
easier than that of any other disease of the heart. But on this
subject I have not leisure to enter at present, nor is it of conse-
quence that I should, seeing that in Dr Corrigan's paper al-
ready referred to, in Dr Hope's work on diseases of the heart,
and in a short essay of mine, published a few years back in the
Edinburgh Medical and Surgical Journal, ahnost all that I
could have to notice is fully detailed. The point which is
chiefly dwelt on in the last of these accounts of the disease, is
the lengtliened interval which occurs between the impulse in
the region of the heart during the contraction of the ventricles
and the beat of a distant artery, such as the radial ; and I
would only mention here, in addition to what I have stated in
that paper of the value of this sign, that it is sometimes present
when none of the other signs commonly considered indicative of
the disease are, — ^in particular when there is no regurgitant
murmur.
CONTRIBUTIONS TO INFANTILE PATHOLOGY. 237
Contnbiitions to Infantile Pathology, By Alexander D.
Campbell, M.B. Oxon, F.R.C. S.E., and Physician-Ac-
coucheur to the Royal Dispensary.
Tu)o Cases of Icterus Gravis Infantum from D^iciency of the Hepatic and
Cystic DuctSy and one from firm Plugging of the Common Duet.
Although some of the following cases belong to that class in
which our professional knowledge can be of but little avail, they
are not without interest or means of improvement to the scienti-
fic practitioner. Mrs R. , the mother of three children (two
of which are alive and healthy), was delivered on the 20th of
February of her third child, a female, having had no children
for four years previously. During this last gestation, shfe
suffered severely from pain in the right side ; but except that,
she had no other complaint than is usual in pregnancy. Her
last labour was tedious, on account of the child being rather
large and well developed. The dajr after the child was born,
its whole body became exceedingly jaundiced ; but as she took
the breast regularly, and evinced no further evidence of indispo-
sition, the icterus did not attract any particular attention ; the
funis separated naturally on the fifth day ; the stools were con-
stantly Ught-coloured ; and the urine possessed a brownish
tinge. On the ninth morning after birth, in consequence as
was supposed of too much milk rushing to the pharynx, and a
little perhaps entering the larynx, a fit of coughing supervened,
which was followed by a discharge of blood from the umbilicus ;
and before the child was seen, it was supposed that the quantity
lost amounted to about two ounces. Caustic and compresses
were used, which suspended the effusion ; there was also slight
vomiting. The next morning I received a message that the
hemorrhage had returned; a graduated compress was now
applied, which again checked the effusion ; on this occasion the
loss had not been so copious. In the afternoon of the same day
the compress was removed, when there was no appearance of
there having been any new discharge ; for the sake of caution,
some of the pulv. alum comp. was applied to the umbilicus, and
the compress replaced; the child, however, died in about au
hour afterwards. The infant took the breast well to the last,
appeared to suffer no pain, and expired without apparent con-
vulsions or coma. Tho remedial measures employed were the
administration of occasional doses of ol. ricini, hydrarg. c. cretfi,
and calomel, all of which operated easily on the bowels, but pro-
duced no change in the colour of the stools. The blood which
escaped from the umbilicus contained a large quantity of bile,
as was evident from the deep tinge of biliary matter communi-
cated to the clothes which received it.
Post-mortem examination forty-four hours after death. — The
skin was universally of a bright yellow or lemon colour {color
238 CONTRIBUTIONS TO INFANTILE PATHOLOGY.
aurantiacus), the body generally was well developed, and o ^ ■ <5i
the abdominal and thoracic muscles, adipose tissue was deposi^tz- ^ci
in large quantity. The cavities of the pleura, pericardium, 2m :mh.c1
peritoneum, contained a small quantity of serum slightly t in( j * ^3cl
with bile; the internal organs, the liver and spleen except^^^<l,
Avere of a pale yellow, and were all perfectly bloodless, x ~ Ibxe
thoracic and abdominal viscera were then removed en mass^ in
order to allow a more minute inspection. The liver natura— Zlljy
first attracted attention ; it was of its normal size, and when ^ezi^^mjLt
into, it appeared somewhat softer than usual, full of bile, and^ oi
the colour of burnt umber. The gall-bladder was very siE:a»_.^a-H
and collapsed, contained only a little mucus, in colour and cczz> za:^-
sistence resembUng gelatine, and formed a close sac hamng -^i-^
outlet y the excretory ducts leading from the gall-bladder and Iv^^^^^i
being absent.
Through the kindness of Mr Miller, surgeon of this city ». 3
have been favoured with the following case of a somewBnB. ^mJL
similar nature. " J. T. presented at birth all the appearaa^zi^^^s
of a mature healthy child ; on the following day the skin w^^ ^MJi
observed to be somewhat yellow, but not more so than in ca*^^ <:>«
of icterus occurring soon after birth. Instead of disappearis:rm. ^"t
however, as generally happens in that mild complamt, -Aii^lie
jaundiced tinge became more deep and permanent. WithL^d^^ a
few days after birth, the abdomen was observed to bo ratBin*-^''
tumid, in consequence of enlargement of the liver. The cti»-ild
sucked well, but was often attacked with diarrhoea and voik=:»-5*^
ing ; the faeces were constantly pale and ash-coloured, and -^fcv^e
urine of the usual saffron hue observed in jaundice. The s^--^^^-"^
was latterly tinged of a greenish brown. With the except ^:^^^^^
of the liver, which increased enormously, so as at least to oocv- HP^
bodithe hypochondriac, the whole epigastric, and the greater p^^^'^^
of the hypogastric regions, and even to dip into the right HL::^^ ^^
fossa, the other organs seemed to remain stationary. 1 "^ -^®
features gradually assumed a peculiarly shrivelled appearan ^ ^"^ ^^
which, with their morbid colour, rendered the child a disgusti.^ -^^^S
object. After surviving six months, it was carried off by ^^^
attack resembling one of cholera, having for some hours h^ic::^^^^
its death incessant vomiting of large quantities of a matter simi^t-^*''
to coffee grounds. On a ^^iv^ixA 'post-mortem examination, neiHSm'^^^
a gall-bladder nor bile ducts could be discoi'ered; the liver ^r^-^"^
verjr much enlarged; the vena portae, hepatic artery, and ^^7
patic veins were all perfectly normal ; the yellow hue pervai^^^
the internal organs generally, but was more particularly remart^^
on the inner coat of the blood-vessels.'*
The following case, in some measure analogous to the tw<>
preceding, I owe to the kindness of Dr Maxwell Adams of ihi^
city: — ''November 1, 1843. — Mrs C. was dehvered, after a
natural labour, of a healthy male cliild ; she had previously had
CONTRIBUTIONS TO INFANl ILE PATHOLOGY. 239
three children, two girls and one boy ; the girls are still alive,
but the boy died on the eleventh day after birth, under circum-
stances wmch will be presently adverted to. On the third day
after birth, the skin of the new-born infant assumed the usual
yellowish tint of icterus rnitis. There was no apparent derange-
ment of any function ; yet the parents of the child, especially the
fether.. expressed great uneasiness for his safety, from the cir-
cumstance of their former male child having become yellow about
the same time after birth. They stated that the yellowness
had increased ; that hemorrhage had occurred from the umbi-
licus on the seventh day, two days after the funis had been de-
tached; that it had continued with lin increase in the yellow
colour of the skin until the eleventh day, when the child died
without experiencing any apparent pain, fit, or struggle, and
only a few hours after partaking of the breast. The case ap-
peared rather a singular one ; but as not much credit is to be
attached to the accuracy of reports of disease by non-medical
reporters, but little attention w^s paid to the recital. To the
child then under treatment castor-oil was ordered to be exhibited ;
and it was attempted to be impressed on the miiids of the parents
that the case was not of such a nature as to cause any unusual
alarm.
" Nov. 4. The castor-oil had operated freely ; the meconium
had disappeared from the stools ; tlie yellow tinge had become
brighter and more vivid, involving the nails and conjunctivAB ;
in other respects the child appeared to do well. Small doses of
hydrarg. c. creta were ordered, together with the tepid bath,
and gentle friction over the region of the liver and stomach.
" Nov. 7. I received a hurried call this morning, the nurse
having observed, on removing the roller, that there was an oozing
of blood from the navel. An astringent lotion and graduated
compress were applied, which had the effect of arresting the
hemorrhage during that day and the succeeding night. The
other remedies were continued at more distant intervals.
Yesterday the cord separated, leaving a clean and healthy
surface.
** Nov. 8. The hemorrhage had returned this morning. The
compress, which was soaked with blood, was removed, and a
cork, made convex at the extremity, and covered with chamois
leather, was substituted. The tinctures of the muriate of iron,
and catechu, alum, and various other styptics, were severally ap-
plied, witli the effect of at least restraining the oozing, which
was not by any means formidable. The child was not teverish,
nor did he appear to suffer pain or uneasiness.
" Nov. 10. The blood continued to ooze away from below the
compress. The use of every means that suggested themselves
to the other medical gentlemen who visited the child was per-
severed in. The loss of blood was inconsiderable, nor was
240 CONTRIBUTIONS TO INFANTILE PATHOLOGY.
there any symptom of fever, spasm, or debility, present ; on the
contrary, the child appeared comfortable and thriving. The
alteratives and gentle aperients were continued with the local
means.
" Nov. 11. I was hurriedly called this morning, and on my
arrival found the child dead. No alteration had taken place in
the symptoms until a few hours before death, when he refused
the breast, and gradually sunk into a comatose state, and almost
imperceptibly expired. I do not think that more than one
ounce and a half of blood was lost during the whole time the
hemorrhage continued.
" Autopsy, — The body oh being stripped was of a bright yellow
colour, plump, firm, and well developed ; and incision was made
from the top of the sternum to the pubes to the left side of the
umbilicus, leaving it, with the vessels entering the liver, entire
for more minute inspection. Adipose tissue was deposited in
large quantity below the integuments. The intestines, fatty
parts, and in fact the whole intOTnal organs, except the liver and
spleen, exhibited the same golden yellow tinge as the outer skin.
'J'he liver appeared slightly congested and more dense than
usual, but there was no sloughing of any of the vessels that had
entered it from the funis, nor was there any trace of disease
about the navel to indicate the source of the hemorrhage. The
mucous membrane of the stomach seemed a little softened, and
there were three or four small spots of ulceration observed upon
its surface, which were attributed to the irritating action of the
medicine administered. The gall-bladder contained a quantity
of bile which could not escape, owing to an indurated cord-like
plug of inspissated bile, which occupied the duct leading to the
duodenum. The umbilical vein contained a clot about an inch
in length. The head was not examined."
Of the preceding cases, the first and third are of the most
interest, and more especially the latter, as in it there was a pos-
sibility of cure, but the former was beyond the power of any-
remedial measures. There are also many points of similarity
between them. In both, the jaundiced tinge showed itself the
day after birth ;. in both, the hemorrhage occurred two days
after separation of the cord, in the one on the seventh, in the
other on the ninth day after birth ; in neither did the children
appear to suffer the slightest uneasiness, but slept well and took
the breast well, until within a very short period before decease ;
in the latter case, its interest was increased by the circumstance,
that the parents had previously had a child affected in the same
way, and which died from the same disease ; and in both, the
children were very stout and healthy, and much adipose tissue was
deposited in different parts of the body. In no author that I have
been able to consult have I found any similar cases. The earliest
writer who advances the idea that icterus is hereditary is Mor-
i
CONTRIBUTIONS TO INFANTILE PATHOLOGY. 241
gaeni : he says, '' In fifteen children of my own, who all became
ywow after birth, and some of them in a considerable degree,
the disorder was naturally carried off in every one of them of
itself, and without the least assistance of art."'* An instance,
however, is given by Underwood, of a lady, the mother of
eleven diildren, nine of whom became jaundiced on the third
day after birth, and all died within the first month ; the tenth
died of the same disease in its sixth month ; and the eleventh
became yellow on the third day after birth, appeared drowsy
and sleepy, and was convulsed. '* On the following days the
colour of the skin often varied, being sometimes of a deeper
yellow, at other times refining nearly its natural colour ; the
child, however, continued m the same state, but received nourish-
ment, and sucked the breast of its mother, till within a few
hours of its death, which took place on the ninth day." On
dissection^ the liver was found nearly twice its natural size,
and in some parts highly injected. The gall-bladder was
nearly filled with bile of a deep yellow colour, and its ducts
were permeable.f
•It IS clear that this jaundice alluded to by Morgagni must
be a very different affection from that* described by Under-
wood; that it is in fact nothing more than the colora-
tion of the skin that goes under the name of ^' the gum,"
a disease (if it deserve the term) that disappears with-
out any treatment at all. Various causes have been as-
signed for the occurrence of icterus in new-born childrcD.
Morgagnij: thought that it arose from the supply of blood to
the hver being diminished by the contraction of the umbilical
vein having extended to the vena portse ; nearly the same
opinion was held by Autenrieth,§ Chambon|| and Jahn
thought that icterus was induced by pressure on the foetal
cranium during labour. We well know that in adults inflamma-
tion and abs(^ of the Hver frequently follow injury of the
head ; but we have yet to learn that icterus is more common in
children born after a labour complicated with contracted pelvis,
or after the application of forceps, than in those born with the
usual ease. BaumesV considers, as the cause of the disease, a
collection of meconium or other irritating matters in the
duodenum, either from the irritation excited producing spasm
of the ductus communis choledochus, or from their actual
quantity, obstructing by mechanical pressure that portion of
* Lib. ill'.. Lit. 48, Art. 60.
t On Diseases of Children, 7tb Edition, p. 31.
t De Sedibus et Causis Alorborum, Epist. 48, Art. 60,
§ Observationes Pathologies.
II Ueber Kinderkrankheiten, Bd. i. Abthl. i.
% M^moire sur Tlctire des Nouveaux-nes.
2h
242 CONTEIBUTIONS TO INFANTILE PATHOLOGY.
the duct which runs between the coats of the duodenum.
Rosenstein* says, " As to the causes of jaundice, we shall find
them to be such which effect a stoppage in the channels that
carry the gall or bile from the liver. Therefore slime, or
glutmous liquids, may cause the jaundice in new-born children
by shutting up this opening " (the aperture of the duct. com.
cbol.) He thinks also that lumps of curdled milk or pap might
have the same effect. It has been remarked both by Rosenstein
and Tissot, that as the duct. com. chol. runs for a space between
the tunics of the duodenum, griping, causing contraction of
the muscular layer of the intestine, will produce constriction of
the canal, showing how very easily the passage of the bile into
the intestine may be obstructed. Various other causes hare
been assigned by different authors, e. g. invagination of the
duct. com. chol. (Fabricius Hildanus) ; sudden chilling of the
body (Boer. Wendt. Joerg.) ; improper nourishment (Cams
Levret et alii). There can be no doubt that we must regard
obstruction of the duct. com. chol. as the cause of icterus : it
is inunaterial whether the obstruction arise from spasm, pres-
sure, or viscidity of the secreted bile ; if it be from absence or
imperforation of the dtict, then we may look upon the affection
as mevitably fatal, although in the second case above related we
have a singular instance of a child having lived for six months
without bile ducts. The absence of a gall-bladder (provided
the ducts are present) need not be regarded as a certainly fatal
malformation, any more than the absence of a urinary bladder,
for they both apparently serve merely as the passive recipients
of their respective secretions, until the proper time arrives for
their expulsion.
From the circumstance of very many children becoming more
or less yellow soon after birth, and from the coloration of the
skin being unattended by any symptom indicative of functional
derangement, and disappearing without the help of art, many
practitioners are inchned to regard this yellowness as an appear-
ance as natural to the healthy child as desquamation of its cuticle.
We must, however, consider this yellowness as a morbid appear-
ance, but perhaps not always pathognomonic of hepatic derange-
ment. When it is so, we should expect to find the coloration
universal and uniform ; but at times we see it confined to the face,
to the trunk, to the extremities, or perhaps to one extremity
only ; disappearing in one part of the body suddenly, to reappear
in another. In this affection the conjunctiva and nails frequently
present no discoloration, nor are the stools of the clay-colour so
constantly observed in jaundice from derangement of the hver.
** Jaundice in children," says Underwood, " seems always to
have been improperly conceived of. Those who have written on
• Rosenstein on Diseases of Children, trans, by Spernuan, p. 200.
CONTRIBUTIONS TO INFANTILE PATHOLOGY. 243
children*s diseases have usually passed it over in silence, whilst
others have considered it rather a serious complaint, and have
, prescribed as for the jaundice of adults. On the other hand,
nurses have usually accounted the yellowness that appears about
the third day after birth, if unusually deep (termed by some the
* yellow gum'), as the true jaundice. Certainly neither of these
opinions is just ; this.(i. e. the true jaundice) is easily distinguished
from the common yellowness by the tunica albuginea being
always (?) very yellow, but the nails are not tinged." The ob-
servations made above being corroborated by so high an autho-
rity, I think we are warranted in concluding that the affection
known under the term " icterus mitis" or " yellow gum," strictly
80 called, does not invariably depend on disturbance of the
hepatic function. But when icterus arises from disordered secre-
tion of bile, the coloration is in general universal and uniform, is
accompanied with symptoms of derangement of the digestive func-
tions, e. g, flatulence, vomiting, griping, and clay-coloured stools,
occasionally also with fits or spasms ; and on dissection the colora-
tion is found not confined to the skin only, but extending to the
subjacent tissues and most of the internal organs. Among the
cases above related there was in one coma, in another vomiting, in a
third diarrhoBa, and in all the Ught-coloured stools, with yellow-
ness, not only of the skin, but also of most of the viscera. There
was, too, another symptom, unusual, and of more importance and
danger, viz. the umbilical hemorrhage. This probably arose from
blood being continually poured into the liver, and bile being
secreted, but finding no exit, the organ became highly congested,
and the most ready passage through which it could free itself
bemg the umbilical vein, blood mixed with bile accordingly
escaped through that canal. The hepatic vein might for a time
serve to carry off the superfluous fluids from the hver, but ulti-
mately, when the congestion increased, it alone proved insufli-
dent. We can thus easily explain the yellowness of all the
tissues, for we may suppose that the bile, unable to escape, either
broke down or permeated the fine tunic of the minute venous
origins, and was thus conveyed by the hepatic veins into the
general circulatory system. In one of the cases above related,
the blood that escaped from the umbilicus coloured the linen
deeply with the tinge of bile, proving that this fluid had entered
the circulation, which it must have done directly, as it was im-
possible that in any of the preceding cases it could first have
been taken up by the absorbents from the intestinal tube. Were
I again to meet with cases similar to the above, I should adopt a
different mode of treatment, on the presumption of course that
the obstruction was not immovable. It appears to ine that the
administration of mercurials is only calculated to increase the
mischief, for they excite the secreting functions of the liver to
greater activity, and bile, which cannot escape, is more abun-
244 CONTRIBUTIONS TO INFANTILE PATHOLOGY.
dantly formed. We ought to endeavour as far as possible to
cause relaxation of the ducts. This object would be attained hj
the application of leeches, the use of the warm bath, with anti-
monial or ipecacuan wine given in nauseating doses only ; for
where there is tendency to umbiUcal hemorrhage an emetic might
be productive of disastrous consequences. If me child appeared
to be much griped, we might presume that the obstruction to the
passage of the bile arose from the duct. com. choledochus being
constricted by contraction of the intestine ; opium and aperients
would then be beneficial.
4 Picaudy Place, July 12, 1844.
Practical Observations on some of the Chronic {or Functioned
Diseases of the Stomach, S^c. S^c. By William Strange,
M. D., M.R.C.S. Edin., Surgeon to the Ashton-under-Lyne
Dispensary.
(Continued from No. III., p. 172.) '
Andral has pointed out a variety of morbid irritation of the
stomach, ** embarras gastrique,*' in which purgatives with eme-
tics are extremely useful, and which indeed appears not to be
amenable to any other kind of treatment, Mr Langston Parker*
also relates cases in which all remedies failed to give reUef until
antimonial emetics were administered. Immense accumulations
of secreted matters were evacuated, and the symptoms imme-
diately disappeared. In dealing, however, with every case of
morbid irritation of the stomach, we must be careful to distin-
guish the original lesion which has preceded the present symp-
toms ; for unless this be done, no treatment will be successful.
Looking upon most kinds of morbid irritation of the stomach as
originating in a want of tonic contractility of that organ, I be-
lieve that there are in reality very few cases which can be
satisfactorily terminated by this simple mode of treatment. The
cases which appear to me to be properly treated by active
purgatives with emetics are those of recent standing, where
there have been errors of diet, principally in regard to quantity ;
as where the meals succeed each other too quickly, without a
sufficient amount of muscular exercise intervening. In such
cases the tongue is loaded with a thick yellow fur, the counte-
nance is puffy or sallow, the conjunctiva jaundiced, the bowels
are confined, with whitish scanty motions, or the evacuations
may be loose and dark coloured. The pulse is generally slow,
full, and compressible. These symptoms depend upon conges-
tion of an active kind both of the liver and stomach, to which
• The Stomach in its Morbid States. 1838.
CHRONIC DISEASES OF THE STOMACH. 245
tlie morbid secretions are of course owing. Whatever clears
away the accumulated secreted matters, and unloads the venous
system of the whole chylopoietic viscera, will therefore relieve
the symptoms at any time, hence the constant recourse had by
free uvers to drastic purgatives ; but a cure can onlv be effected
by a complete change in the dietetic management of the patient.
There is another and in some places much more frequent form
of morbid gastric irritation to be met with, which is by no means
so amenable to the evacuant treatment, '' par en haut et par en
has," so useful in the former kind. Persons employed in
crotfded workshops, such as tailors, milliners, confectioners,
the attendants in many kinds of sale-shops, and the work-people
of our silk and cotton factories, are its chief victims. There is
equally a state of congestive irritation of the stomach, and often
of the liver and the other abdominal viscera, in these as in the
former cases ; but the symptoms are all of a passive kind, and
lead us to suppose that not a hypersemic or congesto-inflamma-
tory action, but a torpidity or a dynamic state of the motor
powers of these organs is the proximate cause of the mischief.
It would be folly to treat these cases with active evacuants,
such as purgatives and emetics. The general an»mic and
often emaciated appearance of the face and form, accompanied*
with want of appetite, languor, and debility, shows that an im-
proved state of the blood and motor powers is required. Guided
by these considerations, I have found that gentle laxatives with
tonics, as the pil. forr. c. aloe., and a mixture composed of a
vegetable bitter, as infus. calumbaB, with the hydriodate of potash,
with once or twice a mild mercurial purge to stimulate the liver,
prove the best treatment.
Such cases, when they occur in young females, are often com-
plicated with chlorotic symptoms, and other indications of de-
ranged menstrual function, palpitation of the heart, sick head-
ach, pain in the loins, &c., and are signally benefited by small
doses of iodine, as in the preceding formula ; replaced after a
time by the sulphate, muriated tincture, or citrate of iron, as
shall best suit the individual case.
Another form of atonic morbid irritation of the stomach is
that which almost always succeeds to excessive hemorrhages or
other evacuations, to menorrhagia of long standing, and to de-
bUitating diseases. There can be no doubt that these cases
admit of no other treatment than the direct tonic plan carefully
executed ; and every means of throwing nutritious substances
into the circulation must be used. It is here that iron may be
said to act as a real specific, as, by increasing the amount of the
red particles of the blood, it gives tone to the enfeebled and
softened parenchyma of the organs. But it is to the dietetic
and regiminal management that we are to look for permanent
amendment in those very common and troublesome disorders.
246 CHRONIC DISEASES OF THE STOMACH.
I do not here make mention of the various means and appliances,
such as change of air, drinking mineral waters, travellmg, out-
door exercise, &c,, which only the wealthy, or at least those in
easy circumstances, can command. My experience of gastric
disorders has been principally acquired at the bedside of the
operative, and it is for his benefit chiefly that I write.
Before we can devise any change for the better in the
hygienic management of the operative classes, we must take a
survey of the circumstances, physical and domestic, by whidi
they are surrounded, and wluch may operate as a cause of the
frequent occurrence of atony and morbid irritation of the sto-
mach amongst them.
I am far from being wishful to recruit the ranks of those who
have written and spoken so much about the baneful effects upon
the health produced by factory employment, and of the nume-
rous diseases peculiar to this class of work-people; and I
believe that extensive observation enables me to assert, that
there is no peculiar disease, nor peculiarly prevalent disease,
amongst the workers in the factories. Indeed, how should there
be ? We know that the same physical causes which are sup-
posed to operate so detrimentally in a cotton factory, exist and
act in many other localities; in fact, in all where numbers of
human beings are densely crowded together. These causes are,
confinement in an unvarying temperature, sometimes a rather
close, and in one instance a very elevated one ; insufficient ven-
tilation ; in some rooms dust and bad smells ; rather long hours
of work, without any great muscular exertion.
Mr Chad wick* has cited instances which came out before tlie
commissioners for inquiring into the sanitary condition of the
labouring population of Great Britain, where 150 tailors worked
twelve hours a-day in a room many times smaller and worse
ventilated than the most unwholesome room in any cotton factory
in Lancashire. The crowding of milliners, too, in close garrets
in London, for twelve, sixteen, or even twenty-four hours to-
gether, is never equalled in any factory. Many kinds of work-
shops, prisons, and public schools are not better.
But notwithstanding that I cannot admit that any peculiar
disease, nor peculiar form of disease, is generated by factory
labour any more than by any other kind of employment in
which the workpeople are equally crowded, it is very evident
that almost all diseases, and the constitution also, receive a very
considerable modification by the action of certain causes upon
the factory population and all that are similarly situated. A
glance at the dense masses of young people, as they issue from
a cotton factory, will strike the stranger with a vivid sense of the
difference between their pallid cheeks and flabby musdes, and
* Report on the Sanitary Condition of the Working Population of Great Britain.
CHRONIC DISEASES OF THE STOMACH. 247
the robust, rosy, and firm appearance of those employed in out-
door labour in the country. If we trace the cause of this differ-
ence, we shall discover the reason why gastric disorders are so
much more frequent amongst the former than amongst the latter
class of operatives. Every thing shows a want of tone or firmness
of the general tissues of the body in those whose employment, in
the midst of large towns, confines them many hours of the day
in a close unvarying temperature, such as that of most factories
and other workshops; the air, surcharged with exhalations,
both from the overheated bodies of the operatives, and from the
greasy machinery, &c., is, in consequence of too often insufficient
ventilation, breathed over and over again without being com-
pletely changed. The muscles of the body become less consis-
tent and tense, and consequently contract less vigorously ; the
skin is relaxed by the warmth of the atmosphere ; the venous
circulation becomes languid, and the capillaries transmit the
red particles of the blood more slowly and in less quantity ;
hence the pallor. As a natural consequence of this state of the
saperfidal circulation, the blood returns in less quantity to the
right side of the heart, and when sent to the lungs, not there
meeting with a sufficient stimulus in the contaminated air inspired,
18 imperfectly oxygenized, and therefore proves an insufficient
stimulus to the left ventricle. Hence arises the weak and irri-
table pulse, the extended contractions but weakened impulse of
the heart. The muscular substance, as 1 believe, in many in-
stances becoming softened, favours the development of dilatation
of the right side, so often accompanying the forms of disease
above described.
We shall not deal too much in hypothesis, if we contend that
from the operation of the above causes, and the disordered
nutrition which is thereby secondarily induced, every tissue of
the body, the parenchyma of all the organs, becomes lax,
softened, and, to use a mechanical phrase, disintegrated; and by
consequence those vital properties which depend upon the close
aggregation of their constituent particles, viz. tonicity and
muscular contractility, become weakened and impaired.
That this very evident though not visible change in the
tissues of the body really takes place in those forms of atony
and morbid irritability of the stomach which I have described, is
argued in a very masterly manner by Andral* in the following
passage : — " Certes, c'est so fonder sur une raisonnable analogic,
et ne point s'ecarter des lois d'une saine philosophic, que d'ad-
mettre que, dans le cas ou les principaux agens de la vie, le sang
etle sys&me nerveux, ne nourrissent et n'excitent plus suffisament
les organes, la force toute vitale d'agregation par laquelle sont
rennies les differentes molecules des tissus vivans, cette force,
* Clinique Medicale, 3enie Edit
248 CHRONIC DISEASES OF THE STOMACH.
dis-je, cesse d'avoir son intensity physiologiq[ue ; de 1^, diminu-
tion de la cohesion de ces tissus, et leur ramollisseinent plus ou
moins considerable, depuis le degre ou, comme on le dit yulgaire-
ment, Uy a JldcdditS dee chairs, jusqu' a celui oil, pendant les
caracteres de Torganization, le solide tend a redevenir liquide/'
Dr C. J. B. Williams* has well remarked, that in proportion
as the tonicity and vital contractility of organs become impaired,
th^ir irritabifity increases; so that the^less susceptible they are
of a normal action from a wholesome stimulus, the more readily
do they take on an abnormal action by the appUcation of morbi-
fic agents. Hence we may understand with what increased
force unwholesome food, errors of diet, intemperate habits, &c.,
act upon the stomachs of those who are daily exposed to the
causes of atony and general debility above described.
I have observed that in most cases of morbid irritation the
domestic management of the operative's fiamily powerfully
seconds the morbific action of the factory or workroom. The
methods of cooking are often very defective, too frequent use
being made, of fatty, raw, and other indigestible substances.
This, together with the very hasty manner m which the princi-
pal meals — ^breakfast and dinner — are swallowed, soon superin-
duces a degree of morbid irritation on the previously existing
atonic condition of the digestive organs.
To provide a remedy for the occurrence of these frequent
disorders, then, we must entertain large views of the necessity
for some kind of supervision of the arrangements as to venti-
lation, site, size of rooms, and other sanitary conveniences of
factories, workshops, and other public or quasi-public buildings.
Without insisting upon too much magisterial interference with
the employment of labour, it would be easy for an influential
and well-educated officer to take care that proper arrangements
should be made for the above sanitary purposes whenever new
factories or similar places are erected ; and that improvements
should be adopted m this department, so far as practicable, in
existing ones. Free ventilation, with abstraction of all dust and
a great deal of the smell, is perfectly attainable, and is in many
instances amply provided for ; and those manufacturers who
have carried out these wholesome arrangements insist upon their
practicabihty in almost every instance.
On the part of the operatives themselves much might be done
by improved domestic economy and temperance, and particularly
by the establishment of pubUc baths at a cheap rate ; a luxury —
I niight say a necessary one — ^possessed by few of the manufac-
turing towns in the north of England.
I would also suggest the adoption of the plan of increasing the
length of the principal meal hours. Half an hour for breakfast
* Principles of Medicine. 1543.
CHRONIC DISEASES OF THE STOMACH. 249
and an hour for dinner is not sufficient for those who have a
considerable distance to go, as more than half of the time is fre-
quently expended in going to and from the place of work. The
meals are in consequence hastily swallowed, and muscular exercise
is commenced too soon afterwards. By extending the time al-
lowed for breakfast to three quarters of an hour and for dinner
to an hour and a half, more time for a short rest would be ob-
tained. The operatives would, no doubt, prefer to have this
extra time after the labour of the day is done by curtailing the
number of working hours ; into this question, however, 1 do not
enter. I merely suggest an improvement in the regiminal
management of the digestive organs.
It is astonishing that, with so many popular works on diet and
the management of health, lectures at mechanics' iustitutions,
and other sources of information for all classes of people with
which the present age teems, there should be such gross ignor-
ance prevalent amongst the lower middle and working popula-
tion. Entirely ignorant of the action of the different kinds of
diet upon the system in sickness and health, they commit the
most dangerous blunders. We must not reckon, therefore, upon
their own good sense in the dietetic management of atony and
morbid irritation of the stomach, but we must lay down for them
an absolute diet-roll, and positively interdict all other articles of
food whatever. We find that those who suffer from bad diges-
tion, the women especially, in consequence of the pain which all
heavy articles cause them, take little other sustenance than
slops, such as tea, broth, gruel, &c., and these often in immense
quantities. Nothing can be more hurtfill to the morbidly irri-
table mucous membrane. The excessive distention completely
paralyses the already adynamic muscular fibre, and the load lies
undigested, until chemical changes from fermentation take place,
which give rise to gaseous eructations, acid regurgitations, heart-
burn, and other distressing feelings. A mild diet, principally
composed of farinaceous articles in a solid form, I have always
found most agreeable to the atonic state of the stomach in these
disorders ; it may consist of rice, bread, sago, or tapioca pud-
dings ; rice, milk, small quantities of good and well-seasoned
broth ; and, after a while, of lean animal food in quantities not
exceeding four ounces at once. Butter, cheese, jellies, and for
the most part eggs, and all other highly azotized substances,
should be entirely forbidden.
8dy Acute morbid irritation, — It is to be lamented that medi-
cal writers are too often chargeable with great laxity in the use
of physiological terms, on the right appUcation of which depends
the comprehension of their ideas by others in the sense in which
their authors conceived them. We find the terms irritation,
iiTitability, sensibility, morbid irritability, and morbid sensibility,
continually used by authors of works on stomach diseases in the
2i
250 CHRONIC DISEASES OF THE STOMACH.
fame sense and to describe the same state of the digestire organs ;
and, on the other hand, many yer j different affections of these
organs are comprehended nnder the same terms. An acute
irntation of the stomach, in which it rejects or refnses to digest
every article of food or drink, is too often designated as an ex-
alted state of sensibility, although there may be no pain accom-
|)anyiDg it ; thus leading the correct physiologist to suppose that
the nervous system is the chief part implicated, when the proper
expression would be acute morbid irritation ; meaning thereby,
that the concord between the food as stimulus and the stomach
as an irritable organ is destroyed, and that instead of a healthy
action, digestion, taking place from the consentaneous operation
of the two upon each other, a morbid action with acute symptoms
results, in consequence of either the stimulus or the irritable
organ having become deranged.
For a morbid action of an irritable organ may be occasioned
in three ways : 1st, The organ itself being sound, an unnatural
stimulus may be applied, — ^as in the case of the stomach, food
highly indigestible, or taken in too large quantities, or too often ;
2d, 1 he stimulus being a natural one, the organ itself may be
in a morbid state, atonic, congestive, inflammatory, &c., and
therefore unable to act on the stimulus in a healthy manner ;
and, 3d, Both the stimulus and the organ being in a healthy
state, yet from idiosyncrasy, climate, age, &c., they may not be
adapted to each other ; whence, in the case of the diet, it follows
that nice discrimination and experience must be used.
Acute morbid irritation of the stomach betrays itself by
such symptoms as cannot easily be mistaken by an attentive
praotitionor. There is acute pain in the stomach after taking
any kind of food, which is not relieved until the latter passes
out of that organ, which it often does by vomiting coming on
either immediately or very soon after food has been taken ;
sometimes such a spasmodic action ensues, that the smallest
Cortion either of food or drink is instantly rejected, even
efore it seems to have had time to enter the cardiac orifice.
When the food is retained and pirtially digested, it is often
forced prematurely out of the stomach ana small intestines,
in consequence of the irritation which the imperfect chjme
produces on the duodenum ; in this case the motions very
much resemble the food which has been eaten. The boweb
are, however, in a great majority of cases, obstinately confined,
and then the reduction of this state is often the first harbinger
of relief. Vomiting also occurs at uncertain int^ervals daring the
d»y, the matters ejected being bilious, or composed of a guurv
mucous fluid> sometimes in immense quantities. There is aim
r^orgitation of acid matter, and occasionally, but rarely, of a
taxless water (water-brash). The tongue* is very yariable in
appearance, it being sometimes very clean, red, and moist ; or
CHRONIC DISEASBB OF THE STOMACH. 251
red and dry, having a baked appearance ; or brown and dry ;
or moist and loaded with a thick yellow fur. The pulse is
either very slow and full, or quick and thready, sometimes
intermitting. The countenance sunk and haggard, exhibiting
signs of suffering. This form of gastric disorder manifests
great variability m the length of its attack and the severity of
its symptoms. In some cases, such is the violence of the
spasmodic action, and the disturbance of the circulatory, re-
spiratory, and nervous systems, that almost instant death is
threatened ; in others, the svmptoms, of a chronic and scarcely
observable state, creep on from bad to worse, until digestion is
iM$arcely performed at all, and extreme emaciation follows.
This is often the case in those aggravated forms of dyspepsia,
as they are called, to which I alluded in a former part of this
paper ; viz., when the complaint begins with a simple state of
atony or debility of the stomach, passing into a low chronic
irritability in consequence of errors of diet or bad treatment,
and thence into acute morbid irritation.
The symptoms have also remarkable remissions. Some
patients are exempt from any very distressing feelings for
weeks or months together ; others have almost periodical re-
missions and exacerbations which are relieved by vomiting a
quantity of mucous fluid. In some instances there is more pain
when the stomach is empty ; but when such is the case, I am
inclined to consider the symptoms as more dependent upon a
nenralgic or upon a congesto-inflammatory action, than upon a
simple irritation of the mucous and muscular coats of the
stomach. The two following cases will illustrate the foregoing
observations.
Case Ist. — ^A gentleman, convalescent from a subacute aitad^ of
bronchitis and pneumonia, contrary to orders, indulged in a
dinner of hashed veal before leaving his bed. In the middle
of the night I was called to him, with word that he was in
a dying state. I found him naked, wrapped up in blankets,
sitting before a large fire, perspiring from every pore, and
rolling about unable to speak from intense agony ; pressing
upon the pit of the stomach, and making ineffectual efforts to
vomit. The pulse was fluttering and not more than eight beats
per minute ; respiration exceedingly short and difficult, as
much so as in acute pleuritis. I instantly administered an
emetic, whidi in less than an hour completely removed the
symptoms. Such was the intensity of the constitutional irrita-
tion in this case, that I believe death would have speedily
ensued had not assistance been promptly rendered. What,
may we suppose, was the state of stomach in this instance?
Inflammatory action could scarcely have been induced, or it
would not have vanished so immediately ; neither was vomiting
excited until the emetic was given. Doubtless the veal acted
252 CHRONIC DISEASES OF THE STOMACH.
npon the stomach in its then adynamic state, the consequence
of illness, as a foreign body, irritating the mucous membrane
and the nerves to the alarming degree I witnessed.
Case 2d, — A young woman of a highly sanguine tem-
perament, nine days after a good delivery (the lochial dis-
charge, which had been copious, having suddenly stopped), was
seized with violent vomiting and purging, for which acet.
plumbi and opium in small quantities were given, with reUef to
the purging. The vomiting, however, continued without
intermission for seven days ; every thing which waa taken —
medicine, food, or drink — ^being rejected before it had remained
in the stomach half a minute. The pulse was throughout the
whole time unaltered ; there was no pain on pressing the
epigastrium, only uneasiness when anything was taken. The
tongue and fauces were vividly red throughout, clean, and with-
out aphthae; in fact, there was no evidence of inflammatory
action whatever. The strength was but little diminished,
although for seven days not a particle of sustenance was
retained. Saline draughts, acetate of lead, opium in substance,
hydrocyanic acid, creasote, and calomel were all tried without
any effect, as were also sinapisms to the stomach and to the
feet. Large quantities of gruel, as a pint at once, were the
first to rest on the stomach, after which the vomiting subsided.
We can scarcely attribute these symptoms either to inflam-
matory action or to irritating articles of food ; as in the one
case more constitutional symptoms would have exhibited them-
selves, and in the other the vomiting, by relieving the
stomacli of the offending substance, would have very shortly
cured itself. Most probably a congested state of the mucous
membrane had taken place, in consequence of the cessation of
the menstrual flux, particularly as large quantities of mucus
were ejected from the stomach.
There is a variety of acute irritation of the stomach which
appears to be owing to a more passive kind of congestion. Con-
finement in a close atmosphere, sedentary occupations, habitually
inhaling mephitic odours, uneasiness of mind, pressure upon the
epigastrium, and bad living, are the most frequent causes of this
form of disorder. In these cases the tongue is generally very
white, with red and elevated papillae underneath the thin fur ;
the edges and tip more or less red, and sometimes indented.
The breath is hot, with a bad odour ; there is almost total loss of
appetite, or a craving only for very savoury and indigestible
food. The muscular strength is much diminished, and the body
emaciated. The urine is high coloured and scanty, and gene-
rally deposits lithic acid, sometimes the ammoniacal salts. The
bowels are often obstinately confined. With these patients di-
gestion seldom takes place without more or less pain, though
vomiting of food occurs only occasionally, and in an irregular
CHRONIC DISEASES OF THE STOMACH. 253
manner. Large quantities of food are secreted b^ the stomach,
and rise in acid or acrid regurgitations, accompanied with flatus.
There is also much gas voided along with the scanty stools.
After this state of things has continued some time, various sym-
Eathetic affections set in, such as neuralgic attacks of the stomach,
eart, .face, or pericranium; sleeplessness, with starting and
fearful dreams ; palpitating and epigastric pulsations, with irre-
gularity of the heart's action ; disease of the kidneys, heart, or
lungs. The following interesting case will exhibit the manner
of invasion of some of these symptoms : —
Case ^. — A schoolmsister, aged about 60 years, had long
suffered from a slight degree ot dyspepsia, arising doubtless
from the confinement consequent upon his occupation, he having
formerly led a more active life. Within ten yards of the school-
house ran an open sewer, into which a little higher up than his
school a factory reservoir emptied itself, the hot water from
which, rising in steam as it passed along, carried with it the
gaseous exhalations of the sewer, the smell of which was most
offensive. About the time of the more acute symptoms making
their appearance, the patient experienced a great deal of anxiety
and grief in consequence of the departure of his son as a mission-
ary, along with the Rev. Mr Moffat, for Southern Africa. At
this time he exhibited many of the characteristic symptoms of
acute irritation of the stomach related above, viz., quick and
irritable pulse, hot dry skin, tongue covered with a thin and very
white fur, the red papillae appearing underneath. The epigas-
trium, always uneasy, was intensely painful after taking any
kind of solid food ; bowels obstinately confined ; face sunk and
careworn; failure of the muscular strength, and emaciation.
Vomiting was only occasionally present. Counter irritation,
leeches, and other antiphlogistic treatment failed to give any
marked relief ; purgatives, bismuth, and tonics were not more
useful. The symptoms increased in severity, until after a while
intense neuralgic pains of the stomach and face came on, the irri-
tation from which afterwards gave rise to twitchings of the limbs
and starting, so that he could scarcely be kept from rolling out
of bed at night or falling from his chair. The stomach was now
80 irritable, and affected with such severe paroxysms of pain,
that I was obliged to restrict him to the very lightest food in
small quantities, and eventually advise him to give up his school
altogether, for which he had been long unfitted by bodily weakness
and extreme depression of spirits.
On exchanging the school for an out-door occupation, the
symptoms of irritation gradually subsided ; he improved in ap-
petite and flesh, and slept better ; but the neuralgia of the face
attacked him several times afterwards, and only disappeared
after a good deal of treatment. In this case almost all the
varieties of gastric disorder which I have enumerated at the
254 CHRONIC DISEASES OF THE STOMACH.
beginning of this paper, as constituting the compound disease of
dyspepsia, were present during some part of the attack. Com-
mencing with an atonic and debilitated state of the organ, it
gradually passed into a chronic state of morbid irritation ; then,
on the accession of fresh causes of mischief, acute irritation,
neuralgia, and perhaps some degree of chronic gastritis, suc-
ceeded.
In respect of the treatment of this disorder, nothing fixed or
certain can be laid down for general adoption. All our remedies
will often fail to give any marked relief; and when the disease
has been of long standing, even the removal of the cause will
not always speedily dissipate the symptoms. Regard must ever
be had to the true pathological condition of the mucous mem-
brane, so far as can be ascertained, and our remedies directed
either against the disordered condition of the organ, or the errors
of diet or offending ingesta, as the case may be. When called
upon to allay urgent vomiting, if we can satisfy ourselves that
there is a congested state of the mucous membrane bordering on
inflammation, which will generally be indicated by a full and
slow pulse, redness of the tongue and lips, and constipation,
we may begin with leeching the epigastrium, followed oy sin-
apisms, an emetic, and afterwards by purgatives of calomel and
aloes, &c. If, on the other hand, the stomach and other diges-
tive organs appear to suffer from a low and adynamic state of
hyperaemia, where there is chronic vomiting only, with acid
eructations or water-brash, I have found the following formula
useful: —
'Be Bismuth trisnit.,
Sodad bicarb, aa. 3i.
Acid, hydrocyanic. gtt. xii.
Infus. calumb. et cinnam. jvi. M.
Half an ounce to be taken every two hours, with the pil. ferri
c. aloe, every night.
To allay vomiting in acute morbid irritation of the stomach
many remedies are m daily use, but all too often fail to act satis-
factorily. No great faith, so far as my experience goes, can be
placed in creasote, hydrocyanic acid, acetate of lead, opium,
effervescing draughts, &c., although each of them is sometimes
successful, especially large doses of solid opium. Large doses
of calomel, 6 or 8 grains, and sometimes small ones, as half a
grain repeated every hour, frequently give great relief. Some
articles of diet occasionally succeed when all medicines are re-
jected, for instance gruel and water, in which a blackened toast
has been soaked. The bowels must be unloaded in every caae.
Dr Abercrombie relates a case from Dr Parry, in whidSi very
small doses of aloes alone allayed a very obstinate Tomiting.
The food, in small quantities, must be chosen according to our
experience of each case. Tonics, cold sponging and bathing, are
CUUABILITY OF HYDROCEPHALUS. 255
useful in completing the cure. I have known the most aggra-
Tated symptoms frequently removed by the patient going for a
week to the seaside.
(^To be continued,)
On the Evidence for the ready Carability of the more acute Form of Hydro-
cephalus in its earliest Stage, and the Practicability of the Diagnosis in the
QeneraHty of Cases, By Alexander Harvey, M.D., Lecturer on the
Institutes of Medicine in Marischal College and Univei'sity, Aberdeen.
I PURPOSB in this second communication on the subject of h3'drocephaIus,
to inquiit; wliether that disease, in its more acute form and in its earliest
stage, is not much more generally amenable to active treatment than many
suppose ; and whether the diagnosis of that form of it may not then be
g^enerally made out with sufficient confidence to warrant active interference.
Though perhaps unnecessary, after the qualified announcement now
made, yet, to obviate misapprehension, I am anxious to avow, at the outset,
my conviction, that there is a set of cases of hydrocephalus to which the
following observations will not apply, t. e, tliat there are cases where the
early symptoms are so obscure as to excite no suspicion of their real nature,
and where the inflammation is from the first of so intractable a character,
or the bodily habit of the patient so feeble, that active treatment can neither
be well home, nor be expected to be of much avail. These cases are gene-
rally somewhat slow in their progress, occur in connexion with inflamma-
tion, era constitution of a decidedly strumous character, and often supervene
on other diseases at their close or during their course. How far all the cases
to which this general description applies are not to be either recognised or
cured in their earliest stage, I do not now inquire ; but setting the whole of
them aside, there still remains a large number of others which may fairly
be brought under consideration in reference to the present inquiry.
I. The acute hydrocephalus being an inflammatory disease, or one ** so
nearly resembling inflammation as to demand the same practical considera-
tion," analogy would lead us to expect that, although (as ample experience
shows) it quickly passes into a state which is nearly beyond the power of
remedies, it should nevertheless in its early stage be equally amenable to
them as any other incipient inflammatory disorder. This expectation,
however, to be satisfactory, must be tested by experience, because we cannot
beforehuid be certain that there is not some peculiarity in that inflamma-
tion, or in the parts affected by it, to render it from the first neai'ly if not
quite incurable.
Is that expectation, then, justified by experience !
In regard to this question, it is obvious that we are met at the very
outset by a serious difficulty. As there is no single symptom, nor any
combination of symptoms, attending the early stage of the disease, absolutely
pathognomonic, we can never be certain that any given case or set of cases,
which seemed to be examples of it, and have recovered under active treat-
ment, either were of the nature they appeared to be, or have been cured by
the remedies made use of. Therefore, in considering the question proposed,
the kind of evidence which the nature of the case admits of must be care-
fully borne in mind. Demonstrative it cannot possibly be. It can never
256 CURABILITY OF HYDROpEI^HALUS.
amount to any thing higher than probability. But ^'probable evidence
admits of degrees, and of all variety of them, from the highest moral cer-
tainty to the very lowest presumption."
Keeping this in mind, it may next be stated that the only evidence which
we either have or can have for the curability of this disease in its early
stage, is,—
1*/, That cases have terminated favourably which presented symptoms,
both local and general, precisely similar to those aitending the early stage
of others which have ended in &tal hydrocephalus.
2<%, That the blood drawn from the arm, in those that recovered, has
been both sizy and contracted (i, e. characteristic of inflammatory disease),
and easUy distinguishable from the blood of incipient fevers, the crassamen-
tum of which is not sizy, and is often comparatively loose.
Qdly^ That the convalescence has been so rapid and complete as to indi-
cate that an inflammatory disease has been cut short; whereas febrile
disease of any kind, not dependent on inflammation, does not admit (as a
general feet at least) of being so quickly arrested by remedies.*
Such and such alone is the kind of evidence by which the question as to
the curability of incipient hydrocephalus is to be determined or can be
eolved. But indirect as it is, and liable to fallacy, yet, if based on a suffi-
cient number of cases, and setting aside many of these as spurious, it may
still be strong enough and ample enough to satisfy every reasonable mind.
What, now, is the positive testimony of pi*actical physicians, of approved
judgment and extensive experience, in regard to the question at issue !
Dr Abercrombiet says, " There is no doubt that many cases have recov-
ered which exhibited all the usual symptoms of hydrocephalus," several
examples of which are given by him in the sequel of his work (p. 146).
And again, " By active treatment, adopted with decision at an early period,
we have the prospect of arresting its progress in a considerable proportion of
cases." (P. 145.)
Dr Watson, j: although he does not give any formal statement on the
subject, suited for quotation, yet delivers his sentiments in such a way as
plainly implies his persuasion of the great efficacy of active treatment when
had recourse to in the early stage ot hydrocephalus ; and, inter aliOy while
he states that " when once it is fairly established, many more die of it
than recover," he adds that " our chance of saving the patient's life by ap-
propriate treatment is alwa^'S greater in proportion as the complaint, or
the tendency to the complaint, is detected early." (P. 428). And again,
after attending to seventy-six cases of the disease occurring in the practice
of difierent physicians named by him, and ot which nineteen recovered, he
goes on to observe that "the cases in which recovery took place were
mostly those in which antiphlogistic measures were adopted early."
(P. 434).
Dr Alison's testimony is even more satisfactory, and is much more ex-
plicitly delivered. After remarking that " the prognosis is always to be
regarded as doubtful, and in all the more complex and insidious cases, or in
cases which are not recognised or neglected in the commencementy as very
unfavourable," he says, ^many well-marked cases, however, particularly
• Brit, and For. Med. Rev., vol. iii. p. 307. — Watson's Lectures on the Prac.
of Physic, vol. i. p. 425.
t Path, and Prac Researches on the Brain. 3d Edition. J Op. citat.
CURABILITY OF HYDROCEPHALUS. 257
•
those in which the early symptoms are most distinct and characteristic,
ntbside complelely under active depletion; particularly full and repeated
blood-letting and purging." (Outlines of Pathology and Practice of Medi-
cine, p. 944.) And he expresses himself still more strongly in an article
(of which he is understood to he the writer) in the third volume of the
British and Foreign Medical Review ; where, after commenting on Dr
Abercromhie's description of the more frequent form of this disease, he re-
marks that *^ a good deal of experience has convinced us, that if this com-
bination of symptoms is seen witliin the first two days, and met by full and
repeated blood>letting (from the arm, if the patient is above three years of
age) and free purging, the greater number of such cases will do well,** What
enhances the value of this remark is the distinct recognition which accom-
panies it of the whole circumstances necessary to be taken into account in
judging of the cases spoken of. " It is very important to observe (says Dr
Alison) that the blood drawn from the arm is very often both sizy and
contracted, and easily distinguished from the blood of incipient fever, the
crassamentum of which is comparatively flabby ;" and again, that " the con-
valescence is so rapid and complete as to indicate unequivocally that an
inflammatory disease had been cut short." (P. 307.)
But perhaps the most remaikable testimony of any on this subject is
that borne by the late Dr Maxwell* of Dumfries, who, according to his
own statement, lost only one patient out of three in upwards of ninety cases.
His practice was bold and hazardous in the extreme, consisting of blood-
letting, and generally repeated blood-letting in the horizontal position, till
the pulse could not be felt, and insensibility, lasting occasionally for some
hours, was produced ; but " in upwards of ninety cases (to use his own
words) that have been treated in this way, above sixty have recovered. In
most of these I Imve had the assistance (he adds) of one or more medical
gentlemen of this place." (P. 13.)
Had tliis testimony been more circumstantially given, it would be easier
to judge of its precise value. Dr Maxwell, indeed, candidly allows the
difficulty of determining how far the sixty cases that recovered were ex-
amples of hydrocephalus ; but he remarks, that as they " did in almost every
symptom resemble those that terminated fatally, we may be allowed to infer
that the disease in both was the same." (P. 14.) He does not, however,
mention the period at which the successful cases were brought under treat-
ment, nor does he say anything regarding the appearance of the blood drawn
or the rapidity of the recovery — important elements in judguig of the pro-
bable nature of the cases. Still, considering the importance of the criterion
stated by him as the ground of his opinion ; his extensive opportunities of
acquainting himself with this class of ciiscs, as is obvious from his observa-
tion, not so much of the successful ones, but of iwenty-seven fjUal cases
after his adoption of his peculiar plan of treatment, and of twenty-five other
fatal cases previously ; and considering also his indirect appeal to his pro-
fessional brethren for the accuracy of his observations, and the correctness
of his statements, — 1 think it were unreasonable not to allow that a lai^e
proportion of the patients that recovered had been really affected with hy-
drocephalus.
An impoi-tant qualification of these general statements is made by Dr
Abercrombie, and acquiesced in by all practical writere, viz., " that the
more the cases approach to the character of active inflammation, our pros-
• Edin. Med. and Surg. Journal, vol. xxii.
2k
258 CURABILITY OF HYDROCEPHALUS.
pect of cutting them short will he the greater ; and that the more they
partake of the low scrofulous inflammation^ it will he the less." (P. 145.)
In regard to these last, however, it is to he ohserved that the symptoms are
very often, perhaps very generally, ohscure ; and Dr Alison makes this im-
portant practical observation regarding them, that ^* in many such cases the
main remedy, viz. blood-letting, is ineffectual, only because the disease is
not recognised, at least with such confidence as to secure its energetic
employment in the early stage " (Brit, and For. Med. Rev., p. 808), — an
observation which, if correct, enliances the impoi-tance of another made by
Dr Watson, that ** we are bound to act, in some instances, upon very slight
indications ; as when, for example, we perceive what we think threatenings
of acute hydrocephalus in a scrofulous child, or in a child belonging to a
family in which others have already been cut off by tliat disorder." (Op.
citat, p. 428.)
Such is the testimony borne by the writers now quoted to the ready
curability of the acute hydrocephalus in its earliest stage under active
treatment. Their evidence is, I humbly submit, quite satisfactory, at
hast in a practical point of view. It may be insufl&cient to prove abso-
lutely the truth of the proposition that the disease is thus curable, or even
that it is curable at all ; but such kind of proof is not available to us, and in
this point of view the question at issue can never be affirmatively deter-
mined. The necessities of practice, however, imperatively demand an
affirmative solution of the question, if possible, and require us to he satisfied
with evidence far short of demonstrative. Allowing, then, that the evidence
adduced has no higher character tlian probability, I contend, nevertheless,
that it amounts to probability of a very strong kind, and that, relying on it,
and in reference to the pi-actical object for which it is adduced, we may
confidently affirm of the acute hydrocephalus, that in its more active form,
and in its earliest stage, it is readily amenable to active treatment.
At all events, it is perfectly clear that the inference now drawn from it
is not in the least affected by any amount of experience of the mortality
from this disease, which has been coextensive with a feeble and undecided
plan of treatment in its earliest stage; and that the conviction of its incura-
bility (whether absolute or comparative), in so far as it is founded on
such experience, is positively fallacious. Such experience is indeed valu-
able, as showing the fatal tendency of the disease when left to itself or
inadequately treated, but is of no value as bearing on the qu( stion, whether
under proper treatment it may not, within the particular period specified,
be equally amenable to remedies as any other acute inflammatory disorder.
And it may be, in point of fact (I hope it is not), the general experience of
the profession, tliat of those affected with hydrocephalus, and seen even from
the commencement, many more die of it than recover, — nay, that the far
greater part perisli ; but it does not therefore follow that such must needs be
the case.
I say it does not follow that such must needs be the case. The fact
may be so, but the inference from it this — ^not tliat the disease is incur-
able, but that the proper remedies are not employed, or that they are too
long deferred, or, if used early, tliat they are not carried sufficiently far.
" There is too much reason to apprehend (says Dr Joy*), that many
children have fallen victims, not so much to the incurable nature of their
case, as to the indecision of their medical attendant." To the same purpose
* Cjc. of Pract. Med. (art. Hydrocephalus), vol. ii. p. 467.
CURABILITY OF HYDROCEPHALUS. 269
are the following remarks of Dr Cheyne :* — ^** Every disease, whose tendency
is to destroy a vital organ, becomes in unskilful hands an incurable disease.
Thus, for example, croup may be considered incurable. * * *, When we
dally with that disease in its first stage, not one in twenty will recover ; where-
as, if the treatment in the first stage be judicious, there will not be one death
in twenty, nor perhaps in a hundred. It is not long since physicians were
more ignorant of the nature of croup than they are now of hydroceplialus ;
the day is perhaps not distant when, better understanding the nature and
import of its early symptoms, hydrocephalus also may lose much of its
danger. In this inquiry some progress has already been made." We
often, indeed, take immoderate credit to ourselves for curing our patients,
when in truth their recovery has been owing to the natural tendency of
their disorder to a favourable tennination, and may even have taken
place in spite of measures directly calculated to defeat that tendency.
But it is worth while considering whether, when they die, we do not
oftener than is really just ascribe their death to an inevitable tendency in
the disease to a fatal result, — a tendency which may have been quite real
and very strong, but so far from inevitable that it might have been obvi-
ated by us. And what if this mistake is not seldom committed in fatal
cases of hydrocephalus \ The question deserves, at least once for all, to be
seriously put to himself, and deliberately considered and answered, by
every one.
If, after all, the evidence now brought forwai-d shall appear to any to
be unsatisfactory, I would just urge upon their attentive consideration,
that there is a very great practical difference between a full satiafactwn of
the truth of the proposition advanced on the faith of it, and a satisfaction
of the contrary. The middle state of mind between the two consists in a
serious apprehension that it may be true, joined with a doubt whether it
is so. And this, upon the best judgment I am able to form, is as far
towards speculative disbelief of it as any one can at all be supposed to go,
who has in any tolerable measure considered the evidence now laid before
him. Now, a serious apprehension that it may bo true that the acute
hydrocephalus is as curable as has been represented, lays us under the
strictest obligations of a serious regard to it, — a regard the same, or in
many respects nearly the same, with wliat a full conviction of its truth
would lay us under.t
It will not, I hope, be inferred from any thing now stated, that I
entertain such an extravagant notion of the curability of the more acute
form of hydrocephalus in its earliest stage, as to imagine that every case
of it brought under treatment at that period may be saved. But there
is a great practical difference between saving sixty out of ninety cases, as
Dr Maxwell thought he did, and losing sixty out of ninety, — ^nay, between
saving the majority of such cases and losing the majority of them. That
a majority of them at least may be saved, I have no hesitation in avowing
my belief. And if I have succeeded in convincing any one of this, who
before was otherwise persuaded, and in inducing him to resolve on treat-
ing such cases, when he meets with them, with prompitudey decisUmy and
energy, the object of this paper will be answered.
II. The practical value of the conclusion arrived at in regard to the
• Essays on Hydrocephalus A cuius, 2d Edition, p. 53.
t Bulter's Analogy, part ii. conclusion.
260 CURABILITY OF HYDROCEPHALUS.
curability of the acute hydrocephalus turns entirely on the practicability
of making out the diagnosis of the disease in its earliest stage.
In judging of the question how &r this is practicable in the generality
of cases, it is necessary to consider, in the fii-st instance, on what grounds
we are entitled in any case at its outset to infer the existence of the disease.
>iow, it is sufficiently clear from experience, that this is to be done not by
trusting to pathognomonics of any kind, but simply by attention to a
certain combination and succession of symptoms, and to the nature and
import of certsiin symptoms which have been observed to attend the com*
mencemcnt of cases which have ended in fatal hydrocephalus.
But these symptoms, it is to be observed, form a part only, and that a
small part, of those which constitute the whole phenomena and tlie
nosological definition of the disease ; and the same or similar symptoms
have often been observed to attend the early stage of other cases which
have turned out not to be hydrocephalus. At this period, therefore, we
obviously cannot pronounce so confidently on the nature of a case, as we
may be able to do on its reaching even the stage next In advance, when
other symptoms may exist more distinctly indicative of affection of the
functions of the brain, or as we may be able to do on its favourable
termination subsequently, under active treatment, without its ever having
advanced to that stage, because, then, circumstances connected with its
maimer of termination, and the effect of the remedies employed, must
have occurred, and will be available to us in judging of what its nature
was.
Nevertheless, slender as may be the grounds of our diagnosis at the
outset of a case, the obsei-vation of a set of symptoms exactly similar to
those known to attend the early stage of h^'drocephalus, is sufficient, in a
practical view, to justify our regarding them as dependent on that disease,
and to demand the remedies for it. It is of no consequence that there is
an equal or even a greater cliance of their being dependent on a different
kind of morbid action, not requiring such remedies, unless it can bu
shown, which I apprehend it cannot, that any injurious effects that
might accrue from the unnecessary employment of those remedies would
outweigh the risk of life incurred from their being delayed or declined
should the case really be of the nature of hydrocephalus. And to wait
till the progress of the case shall throw farther light on the nature of the
symptoms, may be, and in a genuine case of hydrocephalus would
probably be, to wait till such elucidation of them could be of no practical
value.
It cannot, therefore, in my judgment, be too strongly impressed on our
minds, in reference to this class of cases, ** that certain symptoms, and seta
of symptoms, are often invested with a practical importance hardly in*
ferior to genera of disease, demanding and justifying the use of lenwdies
in many cases where it is still uncertain of what disease they form a
part ; — although, in all cases, it is of the utmost importance to obtain this
knowledge as soon as possible, in order to understand the danger that is
impending, and to acquire confidence in the remedies tliat are truly
indicated,"*
But, in truth, I apprehend that in very many, if not the greater part,
of the more acute casecT of hydrocephalus, the diagnosis during the early
• Brit, and For. Med. Rev., vol. iii. p. 303.
CURABILITY OF HYDROCEPHALUS. 261
stage is not an affieiir of such difficulty as the foregoing reasoning may
seem to indicate. ''The diagnosis (says Dr Watson*) is really not so
difficult as it has sometimes been represented." It may be that the
phenomena of the disease have not been more accurately observed of late
years than they were formerly ; but I am persuaded that, since the
pathology of it has come to be better known, the nature and import of the
symptoms, and their relative value and importance, have also come to be
better understood, and that we are now in a position to interpret them
more accurately than our predecessors were forty or fifty years ago.
In reference to this, I may recall attention to the practical importance
attached by Dr Cheyne to an inquiry into the nature and import of the
early symptoms, and to his statements, made in 1819, that ^in this
inquiry some progress has already been made ; " and I think it may be
confidently asserted that Dr Cheyne's own investigations, and the previous
and subsequent ones of other practical physicians, and particularly of
Dr Abercrombie, have tended greatly to accomplish the objects of that
inquiry, and have gone far in enabling us to fix more confidently than
before on the diagnostics by which this disease is to be recognised iu
its first stage, and discriminated from others for which it is liable to be
mistaken.
It is true that there is considerable variety in the early symptoms of not
ft few cases of this disease, corresponding to a certain extent, though far from
generally, to real difierences in the character and perhaps in the seat of the
inflammatory action with which they are connected ; and Dr Abercrombie
has rendered a real service to practical medicine by accurately describing and
arranging those varieties, and thereby facilitating their diagnosis ; but there
is a large number of cases, of more frequent occurrence too than any otbera,
and more acute and tractable in their cliaracter, which are attended by a
tolerably definite, and uniform, and well-marked concourse of symptoms.
These symptoms are — sharp, shooting, or remitting pains of head, impa-
tience of light and sound, sickness and vomiting from slight causes, with
great aggravation of the uneasy feelings on assuming the erect posture,
and fever of various degree, but without the usual general oppression or
depression of idiopathic fever, or of the contagious exanthemata. The pulse
is firm, often peculiarly sharp, but seldom very frequent, and in some cases
almost from the beginning it is slower than natural. In very many cases
the bowels are remarkably costive and obstinate.t Of these symptoms,
perhaps the most important are the sharp shooting pains of head and the
vomiting from slight causes, with the aggravation of both on assuming the
erect posture. The former are well described by Dr Alisonj: as being
" often marked by occasional twinges or stounds oi peculiar intensitt/y causing
the patient to scream out ; and the vomiting as extending to all, or almost
all, the ingesta."
And these two symptoms have of late years derived peculiar significancy
and importance as indicative of the incipient stage of hydrocephalus, — thu
former in consequence of its being now clearly ascertained that the morbid
action constituting thai disease is of the nature of inflammation, of which,
as occurring in internal oi*gans, pain is a very important symptom ; and the
• Op. citat. p. 420.
' + Alison's Outlines of Path, and Pr. of Med., p. 338. CuUen's First Lines, ed.
by Collen and Gregory, voL ii. p. 323.
X Brit, and For. Med. Rev., vol. ill. p* 307.
262 CURABILITY OF HYDROCEPHALUS.
latter, as being now known to physiologists to be an affection, not of the sto-
mach (and therefore not necessarily connected with disorder of that viscus),
but of various muscles, excited, through the spinal cord, by a reflex or
sympathetic action, originating probably in the medulla oblongata, and
remarkably liable to be excited by physical changes in the brain itself.
Of the two symptoms mentioned as the most important, the pain is oIk
viously the more important ; and when existing singly, and having the
peculiar character above stated, is sufficient of itself to excite suspicion of
the presence of the disease, and to warrant the remedies for it. The vomit-
ing is sometimes less observable, or is even wanting ; but it will not seldom
be observed in this case, that medicines given by the mouth produce a greater
degree of nausea than usually accompanies their exliibition, and very often
actual and repeated vomiting. And, lastly, in many cases, whether the
symptoms be well marked or obscure, additional value is given to them, —
negatively by the absence of circumstances which indicate their dependence
on some other kind of diseased action, and positively by the known tendency
of the patient to hydrocephalus.
In concluding this inquiry, I may be allowed to express a hope that no
one will so far misapprehend the scope of my argument as to suppose that,
irrespective of circumstances^ I would set down as being of the nature of
hydrocephalus every case attended with * a pain in the head,' or even with
more of the symptoms met with in cases of undoubted hydrocephalus, and
subject it to the active treatment which that disease requires. But I sub-
mit that this is not the error we are wont to commit, and that the caution
we stand in need of lies all the other way.
Aberdeen, Wth June 1844.
Part IL— REVIEWS.
Tfioughts on tJie Mental Functions; being an Attempt to treat Metaphysics as
a Branch of the Physiology of the Nervous System, Part I. Edinbuigh.
1843.
To medical readers no apology can be necessary for indulging in a few re-
flections suggested by a work on the mental functions. Not only do the
mental functions belong most strictly to physiology ; but there is to be
derived, from a practical acquaintance with the laws of mental operation,
the greatest assistance in the daily practice of medicine, even when that is
not particularly directed to mental diseases. And we have often regretted
that books on this subject are so seldom presented to us otherwise than
under so forbidding an aspect as to deter most men engaged in the active
business of life from attempting to understand their obscurities.
There are, however, one or two exceptions to this complaint. Dr Aber-
crombie's work on the Intellectual Powers is one of the few which puts on
an attractive form. And we can call to mind two other works which,
though somewhat severe on the attention, are free from the overwhelming
load of authorities and counter-authorities, disputations and counter-dispu-
tations of established usage in such writings, we mean Dugald Stewart's
Outlines of Moral Philosophy and Isaac Taylor's Elements of Thought.
The work placed at the head of this article is not a popular exposition
ON THE MENTAL FUNCTIONS. 263
of the old metaphysics, but an attempt to direct the cultivation of that sub-
ject into new channels. It is anonymous, which is rather a disadvantage
to a book on a subject which requires not mere reading but laborious study
before it can be pronounced upon. It is a small volume, of between
two and three hundred pages, and is but a portion of the work, being
entitled Part First. The titles of the chapters, eight in number, will show
the topics of which the volume treats : — On the analysis of phenomena ; on
mental analysis ; on association, with a note on secretion ; on sensation and
volition, including the sensi-motor phenomena that constitute the optic .
tangi-motor system, with a note on the cerebellum, spinal cord, and medulla
oblongatii ; on hearing and the voice, including the sensi-motor phenomena
that constitute the auditory vocal-motor system ; on sympathy and expres-
sion ; on the faculty of enumeration ; and on the craniology of Dr Gall.
There is, besides, an appendix on the physiology of the nervous system, a
note on molecularity, an essay on the physical constitution of gaseous fluids,
and a theory of heat.
After this enumeration of our author's topics, what will most surprise
our readei-s is, tliat it appears from several scattered expressions that he is
not of the medical profession. Of his intimate acquaintance with the prin-
ciples of certain parts of physiology a very cursory inspection of the volume
is sufficient to convince us. Yet we dare not promise to subscribe to all the
views he takes of physiological topics, and to all the uses he makes of them
in his reasonings. Of one thing we are sure, he is a profound thinker, and
as far as we have observed in the portion of his work hitherto published,
for the most paii an exact and sound thinker ; and, though we fear we
di£fer from him widely in many important views, we promise to ourselves
much food for reflection by an occasional recurrence to his pages.
Profound as the work undoubtedly is, it is not equally clear. We could
almost suspect the author of being studiously obscure, did we not know
how easy it is for one to fall into the error of regarding what is clear to
himself as necessarily obvious to all the world. Moreover, we know that
to obtain the pi-aise of clearness in writing we must confine ourselves to
topics which are not obscure. This for the most part in metaphysics is
impossible. It is not of ambiguity we complain — ^there is nothing of a
choice between two interpretations ; it b of a total blank of meaning, till
we have mastered the whole spirit of his discourse on the topic in hand.
We proceed, then, to the particular examination of the work, while we
apply to it, as we trust with due forbearance, those principles which we
firmly believe to be the essence of metaphysical truth.
The plan on which our author treats his subject we consider to be rather
deductive than inductive ; that is, he does not attempt to reduce the ascer-
tained mental phenomena to a small number of general laws, but assuming
certain general facts in the physiology of the nervous system to be esta-
blished, he endeavours to deduce from these the conditions under which
mental phenomena take place. That this is the scope of the work may not
at first sight appear to the reader, because, not to speak of the shadows
thrown over the general plan by the numerous incidental illustrations from
facts, analogies, and inferences in the progress of the work, he has nowhere
collected into one view the principles from which he lias made his deduc-
tions, but brings them out one by one no oflener than he has occasion to
reason from each.
The following few passages will indicate the turn of his speculations on
the subject of scientific investigation in general, when oi*ganic nature is
264 ON THE MENTAL FUNCTIONS.
concerned : — " Analysis, in respect to phenomena, may be defined as the
reduction of particular appearances into the more simple and general, and
as classifying them according to their natural order of dependence or re-
lation. If we seek to discover what are the essentials of all phenomena,
we shall find that there can be no appearance, phenomena, or perception,
without matter in a state of activity. Matter and motion may thus be
viewed as the elements of which all things are composed ; and the dif-
ference between phenomena, as limited to a modification of the properties
of these elements. One phenomenon can differ from another only in so
far as the essential properties of matter and motion admit of change in
kind or degree." — Again, after some explanatory sentences, he says : — ^" The
analysis of phenomena has therefore reached its extreme limit, when it
has resolved them into specific variations, in kind and degree, of the
essential distinguishing properties of matter and motion. The term
analysis is therefore inapplicable to those essential properties. To extend
causation to their existence is in fact absurd, yet it is an absurdity which is
generally overlooked. Our sympathies extend to a final or first cause ;
but the conviction of this existence which is implanted in the human
mind — ^the most enlightened as well as the most illiterate — ^is due to feel-
ing, not to strict causation." — Further on in the same chapter he says :—
** The mental organism which analyzes, views every thing indiscriminately
that presents itself to our senses or imagination as the acted upon ; the
agent is thus for ever sought, and when found, is instantly viewed in its
turn as the acted upon. The fiiculty seeks only to become acquainted with
prior action ; not matter alone, but matter having velocity ; which is
synonymous with motion, force, energy, and is implied in the use of the
active verb. The abortive longing for the cause of abstract existence
does not seem incongruous, nor does the possibility of the creation of
matter out of nothing." Pp. 2, 3, 6, 7.
In the notes on the physiology of the nervous system, our author has
entered into particular details rather than marked out the great principles
on which, as he says in his preface, his views are foimded : — ** The
following attempt to study metaphysics as a branch of the physiology of
the nervous system, is based on the great discoveries in this department
of science that have distinguished the present age« The division of the
nerves into motor and sensitive involves a principle that is all-important
in tracing the primary relations of the mental phenomena. Combined
with association, it seems capable of resolving Uiose difficulties in the
doctrines of sensation which Dr Reid has so ably pointed out in his ** In-
quiry," and which are certainly among the most formidable that beset the
subject. The organology of Dr Gall is another splendid contribution to
psychical science, the ofisprhig of the highest genius ; but, from being too
hastily reduced to the popular standard, its value has been unfortunately
obscured. The usefulness of phrenology in drawing attention to the de-
pendence of the moral on the physical has perliaps more than compensated
for its crudeness as a science." Preface.
What we must regard, then, as the physiological principles on which this
work, as a deductive inquiry, is founded, are such leading fiicts as the
following : — That different nerves have originally distinct offices, as of
conveying impressions from the peripheral pai-ts of the body to the nervous
centre, and of transmitting motor influence from the nervous centre to the
peripheral parts ; that the several component parts of the nervous centre
are endowed with functions from the fii-st separate, and that those several
ON THE MENTAL FUNCTIONS. 265
component parts, or many of them, so communicate by nervous bands, that
the impressions made on one part are capable of originating changes in
the other connected parts, and fnee versa. Besides, it is manifest that his
system rests on the belief that during every state of consciousness there
most arise a change in some part of the material oi^anism. We nowhere
find him directly affirming that such a change in the organism is all that
constitutes a mental operation ; though his frequent use of the ambiguous
phrase "mental organism," might lead the reader to suppose tliat his
system is wholly a system of materialism. We object to the phrase
mental organism as unscientiiie, and think that another expression which
he uses^ namely, mental economy, should everywhere be substituted for it.
Among our author's general principles we must refer also to the trans-
mission to the ofilBpring of qualities acquired by the parent. Of this in
the lower animals it is impossible to doubt, nor even in man, yet in his
case within much narrower limits. The instances to which our author
more particularly points are those recorded by Mr Knight as having been
observed to occur in certain breeds of spaniels.
These must suffice as specimens of our author^s general principles ; for
we have not leisure to search for more of them in the scattered pages in
which they may occur. But before entering on the consideration of the par-
ticular deductions which he makes by the help of these and similar general
principles, we must beg permission to state how far in our opinion it is legi-
timate to rest a system of mental philosophy exclusively on such a basis.
We believe with our author, not because it is proved directly, but because
it rests on the strongest and closest analogies, that every act of consciousness,
tliat is, every mental operation, is accompanied with a change in the
material organism of the nervous system. In one sense, then, we agree
with him that " one phenomenon can differ from another only in so far as
the essential properties of matter and motion admit of change in kind or
degree," But our author, we suppose, limits the term phenomena to ma-
terial substance and motions observed ; but we use the term phenomena in
a larger sense, and include under it states of action which are neither matttT
nor motion — which are discovered without the assistance of the senses, being
themselves states of consciousness^ — (the me) — and the discovering agent —
(the I) — ^being also a state of consciousness.
In ^ort, to say without limitation that matter and motion are the ele-
ments out of which all things are composed, is a flagrant begging of a most
momentous question, by which it is in e£Pect affirmed that mental operations
are nothing but matter and motion.
Our author, in reply, would perhaps suggest the last paragraph of his first
chapter : ** It is to be feared, that if the mind is not fully impressed with the
imperious necessity of applying this physical standard to all phenomena,
whether moral or physical, — if the conviction is not matured and wholly
derived from that experimental induction which has revealed the primary
and most simple relations of matter and motion, — it is in vain to expect that
philosophy will progress towards truth."
We answer — ^by all means go on studying the machinery concerned in the
mental operations ; but do not confound the mere machinery with the power
—do not deceive yourself into the belief that you have discovered the mov-
ing force whenever you have hit on some befoi*e unnoticed combination of
wheels and levers.
It is a striking fact in the history of man's waywardness, that no sooner
is the long-chcrishcd delusion in mechanics — ^the foundation of the search
2l
266 ON THE MENTAL FUNCTIONS.
after the perpetual motion — ^namely, the belief that machinery can generate
power, banished from the popular mind, than straightway even men of
science are found to take up the spirit of the same delusion in what concerns
mind, and to insist on all followers of nature, on pain of being branded as
behind the age, believing that no power is operative in the phenomena of
mind, because some progress has been made in detecting the connexions be-
tween the several parts of the machinery by which the effective power is
applied.
We know that the argument urged against this view is, that it is not in
accordance with the rules of inductive science to receive anything as troth
which does not rest on observation. But we are prepared to maintcon that,
though the science of mind, when based upon reflection on the subjects
of consciousness, may be technically excluded from inductive science, yet
that it in no respect fails to answer to the spirit of inductive science, — ^which
spirit is, to apply to subjects of research the mode of investigation suited to
the nature of each, not in accordance with such fictitious rules of philosophy
as kept men in darkness for ages, but in strict conformity to those precepts
of common judgment by which a great part of our race has risen from
a savage to a civilized state of existence.
While, then, we admit in the fullest manner the study of the structure
and functions of the nervous system, in so far as the observation of the at-
tendant changes of matter and motion is concerned, to be of a high valae
for the advancement of the science of mind, we must insist that there are
other and higher modes by which it can be cultivated — modes which reach
the actual phases of the mental power itself, and not the mei*e operations of
the material machinery through which the power acts and is acted on.
The faults committed in the cultivation of metaphysics on the old plan,
are not proofs of the inadequacy of that plan under better regulation. We
should expect much advancement from the cultivation of mental science on
its old basis, but with such aids as the lights of modem physiology can
supply. The science is still hung round with some scholastic lumber.
We look upon debates as to the existence of an external world, and the
evidence of personal identity, as little better than such questions, as " how
many angels can dance on the point of a needle 1" or •* whether is an angle
an affection of space or a property of matter !'*
No man on this side of insanity ever really doubted of the existence of an
external world or of his own personal identity ; and to attempt to prove
what is intuitive or what became part and parcel of our nature at a period
of in&ncy which memory cannot reach, is akin to nothing sd much
as to the exploded delusion before referred to, which sought to create im-
pulsive power by combinations of wheels and levers.
The great defect of the old metaphysics is the neglect of the study of the
varieties of individual intellectual character. In this respect phrenology
has a manifest advantage. But in the phrenological collection of so-called
factsy it is so difficult to separate the chaff fi-om the grain, that it is
doubtful if any use can be made of them towards the improvement of
metaphysics.
The study of individual intellectual character implies, besides self-obser-
vation, remark on mental operations in others ; and physiology already
affords a basis for this kind of study in the variations of intellectual and
moral character, observed from the earliest times in connexion with those
slight structural differences of form with the predominance of certain func-
tions, which are known as temperaments.
ON THE MENTAL FUNCTIONS, 267
If aay doubt should arise as to the practicability of ca]T>'ing the study
of the varieties of intellectual character to such an extent as to be of use in
the medical profession, we would refer to HoflFbauer s* work, of which Df
Pritchard has made great use in his treatise on insanity, and in particular
to his distinction between stupidity (dummheit) and silliness (bloddnn),
both defective states of mind ; the first being attended with an unusual
obstinacy, the other with an equally remarkable &cility of disposition.
We cannot take time at present to illustrate this interesting topic ; but
we have no doubt that it will be found, in many instances as well as in
those just cited, that certain prominent qualities of mind necessarily imply
other concomitant qualities^ and tliat the discovery of the presence of
one may b$ made the means of inferring the presence of others, which
is manifestly the same thii^ as obtaining the command of a general law*
We have but space to add what we think an a fortion confirmation of our
position, because it has reference merely to a command over one kind of
muscular action. We refer to the undeniable dependence of the character
of the handwriting on the temperament when that is at all well marked.
And this dependence, we are very sure, is the foundation of the power
which some practise, with no small success, of pronouncing on a person's
character from his handwriting, though we believe that many have learned
the secret empirically, without understanding the grounds on which their
success rests.
We would just hint at one or two other modes by which the science of
mind might be augmented. Thus, what can be more instructive in this
department than the consideration of the steps of self-education through
which e^yety in&nt must pass, before the communication of knowledge
through the medium of language begins ; or than the study of those steps
by whieh the human faculties rise, as the objects on wliich they are exer-
cised grow in extent and importance, while man advances from the
humblest condition in which he is known on earth to such an intellectual
superiority as Europe at present enjoys. In illustration of the advantage
to be derived from the former method, we think we could show, did our
limits permit, that the infant at the mother^s breast acquires the idea of an
external world, not by such arguments as metaphysicians use, but by uni-
formly discovering a double consciousness, or one in each of two parts,
when his hand touches any part of his own body, while his consciousness is
as uniformly single, when he touches his mother's breast, or any other
external body.
Besides these sources of improvement, we have no doubt that the know-
ledge of the state of the psychological functions in the lower animals is
destined to throw much light on the operations of the human mind.
With these limitations on the exclusive plan which our author adopts
for the cultivation of the science of mind, we proceed to notice sliortly
Bome of his particular views.
We take the following as the first specimen : —
^ Impressions act upon the organisms of the propensities by means of and
through the perceptive faculties. There must therefore be a class of con-
ductora between the perceptive oigans and the propensities. The influence
which they transmit is probably similar to that conveyed through the
motor nerves; and if we carry out this comparison, each filament is
* Hoffbaiier, Medecine Legale, &c», ou les lois appliquJes aux DJsordres de
rintcUigence. Traduit par ChaiTibeyron.
268 ON THE MENTAL FUNCTIONS,
probably a conductor of tbis inilQence, and isolated from those adjacent.
A very large proportion of the cerebral mass is probably composed of such
conducting filaments." P. 27.
Again : " Memory — the power which a mental oi^nism appears to have of
retaining ideas corresponding to previous impressions from external objects.
The idea beara no comparison with the impression in point of vivid dis-
tinctness, yet it is the true representation of it in all its qnalities of form,
magnitude, colour, &c. If it is the same organic substance that retains an
impress of all those faint images with which the mind is stored, how is it
that they are not confused by interference ! It is evident, from what has
been suggested above, that the impression from without, assisted by a
power from within, effects a cliange of some kind in the organic structure.
• " The sexual passion is excited by the pei-sonal appearances of the opposite
sex ; hence we may conclude, generally, that the change which takes place
In the organic structure, corresponding to such impressions, influences
personal demeanour and action, and irritates the elements of specific action.
We may thus adopt, as an approximate deduction, that perception is
a certain change in organic structure, accompanied with an irritative in-
fluence over certain specific elements of action, and that these may exist
either in a latent or active condition." P. 21.
Again : <*The grand principles of association are nmuitaneouinesstaid Hmi-
laritf/. The agitation caused by an idea or impression lasts for a perceptible in-
stant ; and while another contiguous one is acting, the latter partof the first may
be simultaneous with the first of the second. Similarity ought not per-
haps to be reckoned an original quality of association ; because, when
two impressions are similar, but not identical in all their parts, the com-
parison and recognition of the similarity are distinguished by their respec-
tive simultaneous parts being associated, and marking their difierence in
all paHiculars. It does not require any specific principle of association to
cause like impressions to excite like feelings or ideas. That the mind
should inin from one train of thought to another, both having a eommon
point of resemblance, is accounted for at once by the principle of simol-
taneousness, if we reflect that the point of resemblance is actually an
element of thought identical in both ; and when it is excited in the first
train, the principle of simultaneousness is awakened in the second. It is
therefore active in both, and will carry the mind in the direction where the
ideas have been most vividly impressed." P. 24.
Again : " The two prominent points of the mental economy thus appear to
be, perceptive consciousness and directive effbrt. The passions, or organisms of
the propensities, are the great sources of activity, which are acted upon by
the former, and act upon the latter.
** In motor association, the eflbrt is simultaneous with the degree and
direction of the preceding muscular exertion. Is not a sirotlar conjunetion
of phenomena necessary in all cases of association ! And may it not be de-
fined, as the simultaneousness of an influence that proceeds from ^he seat
of consciousness with another that arrives at it ! " P. 28.
Our author's analysis of volition (chap, iv.) amounts to this — ^that ** two
impressions must be engaged in the internal action — ^vix. 1st, of the part of the
body to be moved ; and, 2d, that of the place to which it is to be moved.
The action in the brain or nervous system to which the motion of the body
conforms, is moving the first of these impressions to coincide with the latter.'*
We cannot afford s])ace to follow him in the long inquiry next entered on
to show the nature of what he tenns tangi-motor and optic-motor pfRfp-
ON THE MENTAL FUNCTIONS. 269
tions in reference to onr power of adapting muscular morements to the
distance and direction of objects. His tang^-motor perceptions are the im-
pressions of consciousness transmitted from the skin without the contact of
external objects, and which carry along with them the sense of position
(p. 66,) His optic-motor perceptions are tlie perceptions of the visual
figure of the body, associated with these tangi-motor perceptions. On this
point we are not more satisfied with our author's account than he is with
that of Sir Charles Bell. We do not feel the difficulty here so strongly as
our author, and that perhaps because we have been accustomed to consider
the surface of the body, at all times afiPected by warmtli, tension, and other
impressions^ as in an especial manner the seat of consciousness, owing to
that great law of sensation by which the states of consciousness originating
in the impressions made on the extremities of nerves are referred back to
the points at which the impressions were made. It Is thus that the infant
at the mother's breast acquires a knowledge of the form and dimensions of
its body. The difficulty then, as it appears to us, does not lie in the attain-
ment of a knowledge of the present attitude of the body, nor in the concep-
tion of the attitude which is to be assumed, but in the explanation of the
nature of that power by which man becomes able so to command his muscles
as to change one attitude into an ever- varying succession of different attitudes.
J'acility in this case belongs only to acts ccMnpounded of those to which he
iias become accustomed. And the difficulty is not merely to discover what
muscular volition is, but what is the nature of those almost painful effiorts
by which one at length le^ms to write, to fence, to swim, to skate. We are
inclined to believe that man has no power by volition over any muscle or
set of muscles, till an impression, originating in the contraction of that
muscle or set of muscles, has reached the nervous centre through the nerves,
the contraction in this first instance being determined by such non-volun-
tary forces as fall under the head of instinct or reflex action. Under this
view, the power over the muscles of locomotion, and we may add of voice,
originates in the same law by which the evacuation of the bladder and
rectum, at first automatic, becomes voluntary.
Our author continues the same subject in a note on the cerebellum, spinal
cord, and medulla oblongata. ^* The remarkable experiments of M.
Floorens have demonstrated, that the cerebellum is an oiganism interposed
between volition and the corresponding motions of the body ; and it is
generally believed to form the connexions necessary for executing combined
movements. Do the preceding views throw any light on its functions ! or
does the necessity of such an organiam tend to confirm the preceding hypo-
theses^ and extend our acquaintance with the economy of the nervous sys-
tem ! Does it organize that association between the tangi-motor and optic-
motor systems which puts us at all times in liarmony with the position of
external objects, and which has ever been so great a mystery in abstract
physiology !
** The simplest effort of volition involves the active state of two impres-
sions of which we are conscious ; but it manifestly involves the active state
of a vast number of associated motor elements of which we are nai conscious*
Is the cerebellum the mechanism that tmnslates the simple cerebral or eoii'
acioiis phenomena of volition into the complex phenomena of muscular
action, and that eliminatea, from the state of the sensitive nerves of the
moflcles and of the skin, the optic perceptkm of position which is associated
with the peripheral consciousness f Pp. 74, 76,
The cerebellum af^^ean to be the depository of those impressions derived
270 ON THE MENTAL FUNCTIONS.
by the nervous centre from the muooles during their contiveUons^ the coB'
tinued existence of whieb, whether as remembered sensations or states of
consciousness, or in some less distinct fbrra, rudimentary of sensations^ in a
rudimentary memory, appears to be essential to the continued voluntary
power over the before-subjected parts of the muscular system.
Our author enters into some very ingenious views on this subject. We
thus interpret his meaning : When a movement is about to take place, there
is a consciousness of the actual position of the body through the sensitive
nerves of the skin, and what we shall call a conception of the intended new
position (dependent according to him on the optic nerves), and these two
states of consciousness belong to the cerebrum — ^to the cerebrum it also be-
longs to will the change ; the impression made on the oiganism of the
cerebrum by this act of will, must be conveyed to the cerebellum by com-
municating nervous fibres; the cerebellum is the depository of those
impressions made during the previous contractions of muscles of which
there is no consciousness, but the continued existence of which is necessary
for ihe repetition of such acts ; the impression made by the act of will on
the cerebellum, through the communicating fibres, brings these stored-up
impressions into activity in so far as required, and thus the fiat of the will
is through motor nerves transformed into a change of attitude. This pro-
cess is illustrated by a diagram/
The vocal-motor perceptions spoken of under the head of hearing and
the voice, are quite analogous to the tangi-motor and optic-motor percep-
tions before made use of. In short, we fear that our author has merely
produced, in this consent between organs of sense and organs of motion, a
kind of hybrid between the old idea of sympathy between nerves and the
more correct modem idea, which makes sympathies to take place through
the nervous centre.
His chapter on sympathy and expression immediately follows. We
extract the following passage : —
** To analyze the sympathetic connexion which expression of counte-
nance, tone, and gesture establish, it is necessary to examine minutely ev^y
link of the chain of phenomena. First the mental excitement has a condi-
tion of the brain to correspond with it. The brain is excited in a certain
specific way. The respiratory facial nerve conveys the specific influence to
the muscles pf the face, which thus experience certain specific contractions.
Now, although we cannot always command our features, or banish from
them the influence of the facial nerve, we are consdaus at ail times of the
eatpresifion that they assume. This is a singular fact, which will stand ex-
amination. The sensitive branches of the fifth cerebral nerve, distributed
to the skin and muscles of the face, may be suflicient to convey an impres-
sion of the state of tension and pressure that aflects it. But this is aooom-
panied with a perception of the expression as it is pictured on the reitina of
an observer; the same impress of expression, in short, is derived from
common sensation, as by visual sensation when lookmg at the reflection of
the face in a mirror." P. 118, 119.
The next chapter is on the &culty of enumeration. The only difficulty,
as it appears to us, which falls under the head of the faculty of enumera-
tion, is the origin of that uncommon power pos8(.*ssed by some persons la
ealculaticm. This we suppose our author is content to explain on phreno-
logical grounds. We cannot admit the power of calculation to be of a
character so special as to require an organ for itself. And we think the
ordinary power of enumeration requires less explanation than almost aoy
ON THE MENTAL FUNCTIONS. 271
Other faculty with which man is gifted. It is one of the most elementary
processes in the mental economy, and flows directly from the exercise of
dmost erery fecnlty of the mind. We are inclined therefore to regard our
author^s explanation as machinery which cumbers tlie subject. Colour, and
the various modifications of sound, are special perceptions as compared with
number. We can understand the necessity for special development for
c^ial perceptions, and if the phrenological head were mapped out with the
organs destined to special purposes only, we should be disposed to listen
much more £sivourably to its pretensions. On this point of the want of
specialness in the perception of number, we have one or two sentences to
add as bearing on an important general view of the mental economy. On
the simple power of recognising the diflfierences of numbers, and of adding and
subtracting the same, depends the whole science of computation ; and these
simple elements <^ arithmetic are of so universal a character, that the exor-
cise of them enters into innumerable mental processes. To recognise unity
is to have the power of reckoning numbers ; to discover that many of our
sensations are not continuous, but interrupted by intervals, is to have com-
puted ; to acknowledge resemblances and differences among our sensations,
is to appreciate the difierences of number. No sooner was man able to
perceive the resemblance between two fingers and two stars, than he had
already apprehended the whole of the abstract idea of nimiber.
It is on such grounds as these that we differ from our author, while we
conclude that there cannot be any special organism for numbers, and that
there is no need of any special theory to explain the operation of mind in
regard to them.
Our author's next chapter turns on the organology of Gall ; a subject,
which for the present we are desirous to avoid. And with regard to his
physical speculations, appended to the volume, w^e feel that such subjects
are not fitted for our pages, even if we were inclined to enter on the discus-
sion of them. We therefore take leave of our author w^ith the expression
of our high respect for his talents, acuteness, and industry ; while we can
truly say, that if our opposition to his views has grown more marked as we
advanced in the examination of them, we have perceived at every step
stronger and stronger proofs of the might of the adversary with whom we
have entered on this, as we truly wish it to be, a friendly controversy.
Facts and Observations on the Sanitary State of Glasgow during the last Year ;
teith Statistical Tables of the late Epidemic^ showing the Connexion existing
between Poverty y Disease^ and Crime. By Robert Perry, M.D., Pre-
sident of the Faculty of Physicians and Surgeons, Senior Physician to
the Glasgow Royal Infirmary, &c. 1844.
Wb are sorry that circumstances prevented us from noticing the above little
work of Dr Perry's in an earlier number, — a place which its merits cei'tainly
deserved. It contains not only many important facts and observations of
the author upon the sanitary state of Glasgow for the last year, but also a
numbers of reports made by the various surgeons of the districts of that
city. It is particularly valuable, as it was then that Glasgow was visited
by that peculiar epidemic which attacked all the large towns of Scotland
about the same time, and which was principally characterized by bilious
vomiting, jaundiced appearance of the skin, rheumatic pains, and relapse.
272 SANITARY STATE OF GLASGOW,
Dr Perry gives a very good account of the various syniptoius, in nowise
however differing from the descriptions previously given by others,* ex-
cepting perhaps that he mentions observing a day or two before the i*elapse
a strong craving for food.
Our author considers it to have been an entirely different disease from
typhus. ** The circumstance of this disease attacking those who had for-
merly passed through eruptive typhus, and being followed by typhus when
the patient was exposed to the infection of the latter, is sufficient to show
that they are totally different diseases both in their character and causes ;
as different as smallpox and scarlatina, or typhus and cholera."
He likewise disbelieves that a similar epidemic prevailed in this country
in 1818. ^ It has been stated that a fever of a similar cliaracter to tlie
present prevailed in this country in the year 1818 ; I have been not an in-
attentive observer for upwards of tliirty years, and have never witnessed a
similar disease in this city."
Speaking of its causes he observes : — ** In looking over these reports
(district surgeons'), one striking feature in the circumstances of the thou-
sands who have suffered most from the present epidemic presents itself;
that is, the overcrowded state of their houses, families of six, eight, and ten
individuals, crowded into one small apartment, without a bed to lie upon,
if we except, perhaps, a quantity of long-used straw or filthy rags, emitting
a stench of human impurity so offensive, that to one unaccustomed to it, is
wholly insupportable, but to which the wretched inmates from habit ap-
peared totally insensible ; those small apartments, being often let by the
week, are filthy in the extreme."
It prevailed to a great extent in Glasgow. " The number of cases," re-
marks our author, "of the present epidemic, repoi-ted to the directors of the
town's hospital, as attended by the district sui^eons during the last eight
months, commencing May 1843, amounted in round numbers to 14,000, as
seen by the table. Of those occurring in Calton, Bridgeton, and Andeiston
districts, I have got no accurate return, but it is certainly within the mark
to estimate it at 7000 ; those in the Gorbals and Tradeston districts at 2000 ;
those treated in the Infirmary during the same period at 9000 ; those who
were attended by private practitioners, not in the poor-roll, at 5500 ; and
those treated in the Barony parish, in the suburbs, without the parliament-
ary boundary, at £00 ; making a total of cases of epidemic fever in Gla^w
and suburbs, during the last eight months, from the beginning of May till
dOth December, 32,000, — exhibiting a fearful amount of poverty and disease,
as it affected the poorest and most destitute of the population. Great as it
is, however, I have been assured by the various practitioners who have at-
tended the poor, that the estimate is far too low."
The mortality which it occasioned was fortunately there as in other
towns very low for the number attacked. " The returns from the Glasgow
Royal Infirmary show a mortality from the fever of 5 per cent. The city
district surgeons estimate theirs at 3 per cent. ; but from the table of the
number of coffins given out by the town's hospital to the poor during the
epidemic period, it is probable that there is some fallacy, as it is known all
the poor on their roll do not apply for coffins, and that during the epidemic
period there was a remarkable immunity from all other diseases. If we
subtract 500 from 1846, it leaves S46, being more than the whole number
* For accounts of the flymptonis of the late epidemic, see Scottish Medical 6a-
aette, pp. 1, 129, 236, 321.
ON PHYSICAL AND INTELLECTUAL LIFE. 273
of coffins given out during the whole of the previous year, giving a propor-
tion of mortality to the epidemic in the city of ahout 6 per cent, during the
eight months of its prevalence ; hut taking the whole at 5 per cent., the
mortality will amount to 1500 as the result of the present epidemic during
a period of eight months."
We cannot conclude this notice without saying how highly we estimate
local reports of this kind, especially when executed with that care and in-
dustry which Dr Perry has bestowed upon his " Facts and Observations."
Wc shall at all times be happy to give publicity to such in our pages.
The work is printed by patients at the Royal Lunatic Asylum, Glasgow,
which accounts for some inaccuracies that cannot escape attention. It con-
tains, however, a well-executed map of Glasgow, with the different districts
more or less deeply coloured as the epidemic more or less prevailed in them.
Lecture on PhyHcal and Intellectual Life. Delivered before the Educational
Society of 8t Mary's^ Birmingham. By Samuel Wright, M. D., &c.
London, 8vo, pp. 68.
Dr Wright is very favourably known to the profession by several valu-
able and interesting contributions to medicine. His papers on the Ergot of
Rye, his Thesis on the Physiological Action of Mercury and its Chlorides,
his Researches into the Pathology of the Salivary Secretions, and other
interesting memoirs, have established his reputation as a most intelligent,
industrious, and successful cultivator of medical science.
This lecture, as designed for a popular audience, brings him before us in
another aspect, as the eloquent advocate of certain great general principles
in physical and psychological science. The object for which it was
designed has lAduced the author to deviate from that close and precise line
of reasoning which the subject would in other circumstances require, and
to render' hb style more elevated, both in the way of general reflections
and language, than would other^'ise have been suited to a metaphysical
and physiological disquisition. Although rather florid to our taste, we
have been highly pleased with the general bearing of the lecture. With
the doctrines regarding materialism and imniaterialism, vitality and spiri-
tuality, laid down by the author, we in many respects concur, and deem
such a popular exposition of those doctrines to be of much practical utility.
They are illustrated by many pleasing and interesting examples derived
from poetry, and natural phenomena, cliemical and vital.
The author has adopted the views advocated by Dr Pritchard in his
work on the vital prmciple. He argues with the materialists, that life is
the result of organization, a property of oi*ganized matter, and with the
immaterialists, that thought is a property of an unknown principle, super-
added to oiganized matter, which we call mindy spirit, or souly an immortal
and imnoaterial entity.
In regarding this entity, however, as the distinguishing feature between
man and brutes, we conceive that he strikes at the root of the arguments upon
which it is contended that thought cannot be a property of matter ; — ^for
who can deny to the lower animals the possession of those qualities which
distinguish mind !
The whole ailment may be comprised in a few words. All the
phenomena of matter, organic and inoiganic, may be referred to a few
2 u
274 ON DYSMENORRHOSA.
general properties common to all matter. Even vital phenomena, he argues, are
not different in kindy but only in modification, from the general properties of
matter. The phenomena of mind, on the other hand, even in its simplest
manifestations, are entirely diflferent in kind from any of the known
properties of matter, and cannot therefore be referred to the same cause.
While the one set of properties, therefore, are ascribed to a certain un-
known cause called matter^ the other must, on the same principle, be re-
ferred to a different ens, which we call mind.
If this argument should appear to confer immortality on brutes as well
as on man, tlie fault is with those who base the doctrine of the soul's im-
mortality upon the proof of its immateriality, and not upon evidence of a
much higher kind. It would be wrong, however, to judge hypercriticaily
on a part of the subject which probably did not come within the design
and scope of the author in the composition of a lecture for a popular
audience.
As a whole, the lecture is alike creditable to the erudition and scientific
attainments, to the head and heart, of the author.
On Dysmenorrhcea and other Uterine Affi ctions in Connexion with Derange-
ment of the Assimilating Functions, By Edward Rigby, M.D., Lecturer
on Midwifery, &c. 12mo, pp. 138. London, 1844.
The volume before us is divided into two parts, — ^the first embraces the
influence of assimilation on the circulating system ; and tlie second is de-
voted to the effects of mal-assimilation on certain uterine derangements.
In his preface the author very modestly states that he hesitates to submit
his observations to the profession, as his investigations have not been so
perfect as he could wish. But notwithstanding this deficiency, as Dr Rigby
informs us that he not only enjoys an extensive field for his inquiries, but
that since 1831 he has devoted his attention to the subject under considera-
tion, we have more than ordinary encouragement for noticing his exertions.
We regret, notwithstanding our favourable anticipations, to be obliged,
in the very commencement of our strictures, io differ in opinion from the
author, who states (preface, p. 1), that "these affections on the whole
excite less interest among the generality of the profession than any other
class of diseases." With the sentiments of the generality of our brethren
south of the boundary we cannot pretend to be acquainted ; but some of
them, we can state with confidence, do not participate any more than we
do ourselves in the foregoing sentiments. We can well remember, that
from the time we could pretend even to a very moderate share of practical
knowledge of female diseases, individuals affected with dysmenorrhoea, more
especially matrons, excited considerable solicitude, from this derangement
being not only very difficult of removal, but being also almost invariably
accompanied by sterility. Of this latter fact even females themselves are
not ignorant ; for we presume that other members of the profession as well
as ourselves have been consulted by mothers as to the propriety of young
females contracting a matrimonial alliance while suffering fVom this variety
of menstrual derangement. Moreover, if dysmenorrhoea has not sufficiently
commanded the attention of some of our brethren, this must be ascribed to
their having been but indifferently gifted with the power of observation,
since it may unquestionably be followed by very distressing results. We have
ON DYSMENORRHOSA. 275
long been of opinion — and our sentiments have been satisfactorily corrobo-
rated by Dr Lever in his excellent work on Organic Diseases of the Uterus,
noticed in the first number of tins Journal — ^that females who have been
martyrs to painful menstruation are very liable, at an advanced period of
life, to be the subjects of cancer uteri, — a fact which is nowhere noticed by
the author of the work under review.
The first thirty-five pages of this work are occupied with a repetition of
Dr Front's sentiments regarding the influence of mal-^ussimilation. To enter
on an analyds of these speculations would be inexpedient, since they have
been for some time before the profession, and must be familiar to most of
our readers. We shall merely content ourselves by making some observa-
tions on the causes of chlorosis and dysmenorrhcea, the most obstinate of
the affections treated of by our author, who has not at all acquitted himself
on this head so well as we were led to expect, considering the advantages
he has enjoyed. If mal-assimilation from defective and improper nourish-
ment were influential in producing these diseases, they ought to be very
prevalent among the humbler classes, who are most exposed to such causes ;
but that the reverse is the case, considering their numerical superiority,
must be well known to all practical men. The circumstances most condu-
cive to the aflections refciTed to are originally feeble corporeal stamina, a
strumous diathesis, long continued mental distress, a sedentary occupation,
breathing an impure atmosphere, and a laborious employment ; and when
combined with these, it is not improbable that the causes above noticed
may exert considerable influence. What possible analogy Dr Rigby can
find between dysmenorrhcea, gout, and rheumatism we are at a loss to dis-
cover, except that they are all attended with pain ; and upon the same
principle we may erelong expect to be informed that dysmenorrhcea is allied
to colic, tootliache, and earache.
The next forty-five pages are devoted to the symptoms and treatment of
dysmenorrhcea chiefly ; and, giving the author all due credit for his industry,
we cannot help observing that there are some obvious contradictions in this
portion of the work, and that the symptoms have, in some respects, been
liar too minutely described. For example, at p. 37, we are informed that
there is heat, swelling, redness, and pain ; and at p. 48, that not unfrequently
tlie canal is so exquisitely sensitive as to render the introduction of the finger
very painful and sometimes even impossible. Again, at page 61, we are told
that " the passage is too irritable and swollen to bear the introduction of an
instrument." It has never fallen to our own lot to meet with cases attended
with symptoms so violent ; and we are naturally led to ask the author how
he can undertake to speak so confidently regarding the condition of the
sexual canal, when neither a finger nor an instrument could be introduced
for the purpose of exploration !
As specimens of over minuteness in describing symptoms, we may notice
the following : '^ There is a bilious headache across the forehead (p. 41) ; the
labia and nymphs are usually found swollen and flabby, and copiously
moistened with a thick, creamy, albuminous discharge (p. 42) ; it is every-
where covered with the above-mentioned white or yellowish- white dis-
charge (p. 43) ; the fecal mass is ensheathed by the mucous secretion, and
although formed, and even solid, glides from the intestine with that degree
€Kf ease," &c. ; and again, " a secretion of gas takes place in the vagina, and
also in the rectum." Our readers will, like ourselves, be naturally curious
to know what description of ladies could be so communicative to Dr Rigby.
Such minute details might have been expected of a physician writing in
276 ON DYSMENORRH(EA.
those times when our hrethren were required not only to examine hat even
taste the urine and fieces of their patients ; hut in the present day we are
sure no writer would incur the censure of a reviewer for dispensing with
them.
The treatment pursued in the suhjects embraced in this puhlication is, to
say the least, judicious ; hut, in passing, we cannot avoid noticing a novel
mode of using one of the preparations of opium recommended at p. 61, viz.
*^ to apply to the vagina, hy a camel's hair pencil, some almond oil with a
little extract of poppy or liq. opii sedat. That in, the present day the fe-
male organs are examined with a degree of freedom which, thirty years ago
even, would not liave been tolerated by the sex, and remedial measures adopted
which it would have been hazardous in the extreme to propose to them, we
are ready to admit ; but we must reprobate such conduct in the strongest
terms when the relief of ihe patient can otherwise be as efficiently accom-
plished.
The remainder of the worlc embraces some cases in illustration, and the
modes of analyzing the urine, which, though as we believe founded on sound
information, we shall leave our readers to consult for themselves, as we have
already extended our observations beyond the limits usually appropriated to
works of this magnitude.
Part III.— PERISCOPE.
ANATOMY AND PHYSIOLOGY.
Doubts as to KiemarCs Views of the Structure of the Liver,
Kierkan's observations upon the structure of the liver, and the relative
positions of the component tissues of that oigan, have been very generally
believed by anatomists and physiologists of the highest authority to be
correct.
Kieman considers, as is now almost universally known, that he had
from direct observation proved that the capillaries of the vena porta: com-
municate with the radicles of the hepatic veins ; the latter being situated
in the centre (the intralobular veins) of the acini or lobules of the liver ;
the former ramifying between and upon the surface of these bodies — the
interlobular and lobular veins — and that the liepatic artery is the vessel
that furnishes the supply of nutritious matter for the nourishment of the
biliary canals, the arteries, veins, and the envelopes which isolate the
acini from each other.
These statements are to a certain extent opposed to a series of observa-
tions contained in the fourth number of Muller's Archives for 18i3, made
by MM. Weber, Krukenberg, and Miiller.
The objects which MM. Weber and Krukenberg have in view are to
demonstrate the existence of vascular capillary reticulations, which are the
last ramifications of the vena porta, and the radicles of the hepatic veins ;
the meshes of which are occupied by the biliary canals, which, like theia,
also forms a complete network. These writers state, moreover, that the
hepatic artery communicates directly either with the vtna porUe or the
capillary network, thus differing in reference to this latter point completely
from the views entertained by Kiernan.
THE STRUCTURE OF THE LIVER. 277
MM. Weber and Krukenbeig denj the existence of acini. They be-
lieve that the liver consists of a continuous mass, in which the vessels and
ductsy situated in distinct channels, are placed.
The smallest ramifications of the hepatic vein are distributed between
those of the vena portcB, but at a sensible distance from each other ; the
space between them being filled up by cellular tissue, and by the com-
mencement of the hepatic ducts.
M. MuUer, however, supports the old opinion of the division of the liver
into lobules or acini ; and states, that if Weber and Krukenberg have not
been able to see the cellular and fibrous tissues which envelop these, it is be-
cause the injection used has so distended the vessels as to obliterate by
pressure the interlobular spaces. Miiller states, that to exhibit the acini
distinctly, it is merely required to macerate the liver in acetic acid for eight
days or so. By this process the cellular tissue is destroyed, the lobules
remaining suspended by the radicles of the hepatic veins. The terminations
of the biliary ducts have not yet been observed by Miiller, although this
excellent observer has looked for them with the greatest possible assiduity
and care. MM. Weber and Krukenberg state that they have succeeded
in demonstrating the existence of a plexiform network formed by terminat-
ing branches of the biliary ducts, in the meshes of which the vascular
capillaries are placed. — From MiilleT^s Archives^ No. iv. 1843.
SURGERY.
On Ea^cision of the Head of the Femur. By Dr Ed. Bonino.
In the April number of the Annales de la Chirurgie there is a memoir on
this operation by M. Bonino, and in the same journal for May he has pub-
lished the history of two additional cases, the account of which he had
received subsequently to the publication of his first paper. The cases
which he has collected amount to twelve in all, and we shall append an
abstract of them, as, with the exception of two of them, they are but little
known in this country.
The first case which he relates is the one by Mr Whyte of the West-
minster Hospital, who we believe was the first who actually performed
this operation. On the Continent, surgeons appear to doubt that he actu-
ally performed the operation, believing that he limited himself to its pro-
posal. That he did so, however, and with suc-cess, is well known in this
country, as the case was published in the London Medical Grazette in 1832,
and the parts removed are still preserved in one of the London museums.
We find, likewise, that the case is alluded to with approbation by his
colleague Mr Guthrie, in his clinical lecture, in the following terms : —
*^ Mr Whyte, my colleague in this hospital, removed the head and neck of
the thigh bone in a young person, by a very simple operation, after it had
been dislocated by the same disease, ulceration of the cartilages and head
of the bone, because it was evidently causing great irritation. The patient
was a boy aged fourteen years, and recovered, with a useful articulation,
and without the limb being much shortened."
The second case which he gives is published in the Gazette Medicak for
1885, and occurred in the last expedition of the Russians against tlie
Turks in 1829. The operation was performed by M. Oppenheim. The
patient had been wounded by a ball in the left coxo-femoral articulation.
On enlaiging the wound, M. 0. found that a comminuted fracture of the
278 ON EXCISION OF THE HEAD OF THE FEMUR.
head of the hone existed, and that a portion of the upper border of tlie
cotyloid cavity had been detached. He removed the injured parts with
some difficulty, and the case held out very fair prospects of success until
the seventeenth day, when the man was much alarmed by the occurrence
of a case of plague in the ward, and the same evening intense fever super-
vened, and he died next day.
The thu'd case in which the operation was performed was by M. Sentin,
at the siege of Antwerp in 1832, likewise for fracture by gun-shot wound
of the head of the femur and trochanter major. For a few days the man
did pretty well, but gangrene of the limb supervened, and he died on the
ninth day.
The fourth case was by M. Schmalz, in Saxony, for caries of the head of
the bone, which was already detached from the shaft. The boy was cured
after a lapse of three years, and a new joint was formed by the trochauter
major.
In the fifth case, the operation was performed by Mr Hewson of Dublin
for caries. The bone was divided above the trochanter minor, but the
patient died three months aftenvards from abscess in the pelvis, connected
with disease of the cotyloid cavity.
The sixth case given was by Schlichting, in 1829. Tlie patient was a
young girl st. fifteen, and was cured in six weeks, being able to walk
easily with a little halt.
The seventh case was by Kohleren Heine of Wurtzburg, and was like-
wise successful. The eighth case was by Kluge, and likewise for caries,
but the patient died on the second day.
The ninth case was by Vogel, in a young girl affected with morbus
coxarius, and was successful.
The tenth case was by MM. Jaeger and Textor, in a child of seven and
a-half years, with fracture of the neck of the femur and abscess. It was
unsuccessful, the patient dying on the twenty- third day.
The eleventh and twelfth cases were both by Textor, for disease of the
upper part of the bone, but both were unsuccessful, the first dying the day
after the operation, and the second on the fifty- third day.
In the remarks with which M. Bonino follows up the enumeration of
these cases, he advocates strongly the propriety of the operation under
certain circumstances, contrasting it with amputation of the extremity, the
operation hitherto recommended, and giving it a decided preference, as we
agree with him it ought to have.
We have here, in the twelve cases, five which succeeded perfectly, a
favourable result which the most strenuous advocate for amputation could
never look for ; and if we were to put out of the. question those cases in
which the operation ought never to have been performed, and of these
there are several, this practice would of course contrast still more favour-
ably with the other. When we consider, in addition, the fact that the
limb in all the cases has been left in a state well adapted for all the
ordinary purposes of progression, &c., we conceive tliat the two operations
will scarcely bear comparison.
We find that our latest writers on military surgeiy speak highly in
favour of the operation. Mr Guthrie, in his clinical lectures, speaks thus :
** I liavc not done this operation on a living man, but you must do ity and I
am sure that in the end you will succeed. You ought not to be allowed
to take out a limb at the top joint, unless the head and neck of the thigh
bone are injured ;. and you ought not to take it out if they ane, unless the
ON EXCISION OF THE HEAD OF THE FEMUR. 279
shaft of the thigh hone is irreparahl}- injured also.*' Sir G. Ballingally in
his Outlines of Military Surgery, says, " The hazardous character of wounds
inTolving the hip-joint is well known to every experienced surgeon, and the
removal of the thigh at the hip-joint, recommended for some of these wounds,
is an operation which no one can contemplate with any sanguine hopes of
success. The experience of the excision of the head of the femur in cases
of caries is not extensive, hut it appears to me to he encouraging ; and since
I have become familiar with the excision of other joints, I have frequently
reflected upon the possibility of substituting the operation of excision for
that of amputation at the hip-joint, in some of tliose cases of gun-shot
wounds where the latter has been recommended. And I am now encour-
aged to speak with more confidence on this point from finding the operation
advocated by one of the first authorities in military surgery, Mr Guthrie,
in his clinical lectures recently published." M. Bonino does not deny the
fact that the operation is a very serious one ; on the contrary, he admita
that it is ; but he very justly remarks that this is by no means a sufficient
reason for rejecting it altogether. Serious operations are always authorized
by the circumstances which demand them — ^they are only legitimately per-
formed, in fact, in diseases which if left to nature inevitably lead to a fatal
result. The severity of the operation is then, if we may so speak, propor-
tioned to the serious nature of the affection which demands it.
In all these cases, then, in which any hope of recovery by surgical inter-
ference is oflRered, the surgeon has only the alternative of choosing between
excision of the head of the bone and amputation at the articulation. The
question then is not whether excision be a severe operation — this no one
doubts — ^but whether it be less severe than amputation.
M. Bonino then proceeds to draw a comparison in detail between the two
operations. We shall not follow him through that part of his paper ; the
result of his comparison we have already given.
The cases in which he recommends the section of the head of the bone are
the following :
1*/, Dislocation, with protrusion of the head of the bone through the soft
parts^ which it is found impossible to reduce,
2rf, In gun-shot wounds involving the upper part of the bone.
Sdy In caries of the upper part of the femur, whether primary or
secondary.
In regard to the two first, the opinion of the profession appears to be
very much at one, but in regard to the last there is still, and very naturally,
much difference of opinion.
The great objection to interfering in cases of caries consists in the fact
that the cotyloid cavity is very generally involved m the disease, and
likewise in the difficulty, we might almost say impossibility, of saying
when it is not. Any operation undertaken when this part is affected is
woiTse than useless, as we only remove part of the disease, leaving behind,
perhaps, the portion most likely to lead to a fatal result. Such indeed
appears to have been the cause of death in some of those operated on.
M. Bonino appears to agree with those authors who believe that the
head of the bone is first affected, and the cavity secondarily, and argues
that if the affection of this part be not extensive, and being as it were the
effect of the caries of the head of the bone, we might hope, having
removed the cause, to see the diseased action in this part checked at its
commencement. We cannot agree with M. B. in this, and are of opinion
that if there be evidence of the cotyloid cavity being affected, that
280 CASE OF TETANUS.
surgeon will best consult his own reputation and the good of his patient
who declines interfering. We cannot conceive that the cautery, as recom-
mended in such cases by Briat, or the gouge and mallet, by Moreau, would
be of much avail. We ought in justice, however, to add, that in two of
the cases related, the cotyloid cavity was unaffected, and that amongst the
five successful cases, thive were perfonned for caries involving the articu-
lation.
Ca9e of Tetanu9 foUowing the Medtanical Cure of a Fistula Ladirymalu,
By M. Petbi.
Case. — ^A woman, aged fifty, of a lymphatic temperament, subject for a
length of time to a rheumatic afiection, wished to get rid of an epiphora
which annoyed her. In consequence, a surgeon Incised the diseased parts,
introduced a seton (meche), and after a time the nail-headed style of
Scarpa. During all the operation, the patient coropliuned of a pain which
extended &om the artificial canal to the eye, to the cheek, to the forehead,
and to the angle of the jaw. E^ht days had elapaed, when, after a sleep-
less night, the patient found that she could no loi^r open the mouth. In
the evening, M. Petri found a contraction of the masseter and temporal
muscles, as well as general convulsive movements. He proposed to remove
the style from the lachrymal sac ; but the ordinary medical attendant^ who
did not see in these symptoms any thing but a rheumatic afieeUcm, would
not consent. The treatment^ therefore, was limited to a blood.letting and
to twenty leeches applied to the neck. The following day, the rigidity
had extended to the muscles of the neck and of the trunk ; those of the
arms became afiected In their turn ; lastly, the convulsions became general.
The style was then withdrawn, and opium was administered ; but, not-
withstanding a deceitful remission, the patient sunk at the commencement
of the fourth day« — Sectio. The lachrymal passages did not present any
extraordinary injury. The rest of the body could not be examined.
Dr Betti, to whom M. Petri related this case, told him that formerly he
liad seen a patient seised with trismus at the moment when Yacci intro-
duced a seton (meche) into the nasal canal. That celebrated suigeou,
suspecting the cause of this accident, immediately removed the foreigu
body. The trismus subsided in a short time ; and afterwards there was
no more thought of curing the patient of the fistula lachrymals. — ^From the
Gazzetia Totcana deik Scwnsee MediahFinchey in the Gazette MSdicak,
18 May 1844.
Wound of the Beart apparently Cured. By M. Mabiki.
Case. — ^The patient, Angela CeccareUi, aged thirty-two^ received, on the
11th July 1848, a blow with a knife in the region of the heart She fell
in a fiunty losing a considerable quantity of blood. M. MAwni^ who was
called in immediately, found her fidlen into a profound sinking, covered
with a cold sweat, witii di£Bcult respiration, repeated syncopes, and a flut-
tering and unsteady pulse* The wound was situated on the inner side
of the breast, at two inches and some lines from the sternum. On con-
sidering its direction, it was found that it penetrated between the fourth
and the fifth rib. Judging from these signs, M. Marini concluded that the
patient was in danger of death, it being very probable that there was a
wound of the pericardium. She was carried to the hospital, and finding
WOUND OF THE HEART APPARENTLY CURED. 281
herself a little better on the foUowing day, she was examined by another
medical man, who declared that the wound was a simple penetrating one,
and would hardly lead to filial eenseqnences. The patient not having been
confided to the care of tile author, he only knew that six or seven blood-
lettings and repeated iqiplications of leeches were had recourse to, and that
on several occasions she was in imminent danger of death. However, the
external wound cicatrized, and the patient was dismissed firom the hospital
on the 26ih August, declared perfedly cured. She was seen for some time
after going about the streets, presenting the signs and marks of wasting
away. At last, on the 16th September, having got up very early to satisfy
a call, she fell suddenly, and died in a few minutes.
Sectio, — The external cicatrice was solid and complete. The reuniting
tiaaae which followed it could be easily traced between the fourth and fifth
ribs to the interior of the chest. The sternum being elevated, there escaped
from the left tlioracic cavity half a pound of inodorous lymph of a clear
yellow colour. A point of the pericardium presented an abnormal thick-
ening, as well as traces of an inflammation not altogether subsided. There
existed numerous and solid adherences of the summit of the left lung. A
cyst of a bluisli-black colour, filled with coagulated and fluid blood, ad-
hered by a large pedicule to the left side of the pericardium. The pericar-
dium being raised up and opened, it was found filled with clotted and fluid
blood, the quantity of which was estimated at about two pounds. The
heart was atrophied, thinned, and fall of blood. It was penetrated near its
point by a round and conical hole, which, like a sphincter, communicated
with the left ventricle. This opening, sufficiently large to admit easily an
ordinary pair of forceps, presented at its circumference a sort of whitish
callosity, soft and smooth, which corresponded exactly to the above-
mentioned cicatrice of the pericardiam. — From the // Raccoglitore Medico^
and given in the Gaxette MSdicaley 11 Mai 1844.
MATERIA MEDICA AND DIETETICS.
Valerianate of Zinc in Neuralgias and in Chronic Satyriasis,
The valerianate of zinc was suggested for use as an antispasmodic by
Prince Louis Lucien Bonaparte about a year ago, and has since been much
commended chiefly in the Italian journals of medicine. In the last number
of the «• Gazette Medicale de Paris" for June of this year, Dr Fiancis
Devay of the Hotel Dieu of Lyons has published an interesting memoir on
this new medicine. Dr Devay does not find the physiological action of this
drug to be greater than that of valerian or of zinc separately, but he regards
its medical efiects in certain diseases, as in epileptic maladies and nervous
afi^ectionsyss prombing to be of the greatest service. He abstains from pub-
lishing any account of its good effects in the more serious forms of disease,
till a longer time has tested their permanence. But in this memoir he
reports four cases of neuralgia and one case of chronic satyriasis, which,
after resisting the oi-dinary ti-eatment, were completely cured by this re-
medy. The following is his prescription : —
R Valerian, zinc. . . gr. x. (6 decigr.)
Gummi tragancanth. . . 388. (2 gram.)
Ft. pill. xii. Sumat. unam mane et vespere.
As want of room prevents us from giving any further account of this
memoir, we probably shall recur to it in a future number.
2 N
282 ON THE TREATMENT OF SYPHILIS.
PATHOLOGY AND PRACTICE OF MEDICINE.
"We this month lay hefore our readers an abstract of a paper by Dr
Hocken, " On the Comparative Value of the Preparations of Mercury and
Iodine in the Treatment of Syphilis," which appears in the April number
of the Edinburgh Medical Journal.
Recent changes in our opinions respecting syphilis have teiided much
to perplex pi-actitioners as to the proper method of treatment ; the opposing
parties have probably each been too exclusive ;' and we regard the paper of
Dr Hocken, though containing nothing original, as valuable from its con-
densing the opinions of the most trustworthy writers on the disease. We
shall take the liberty, however, of still farther compressing it.
On the Treatment of Syphilis by Mercury and Iodine, '
1. Syphilis can be cured without mercury. — 2. This does not prove that
the non-mercurial treatment is the most advantageous. — 3. The main points
are to know where to employ mercury and iodine, and when to refrain from
their employment. This is discussed under three heads.
1*^, /* the plan of treatment by mercury and iodine superior to any other ^
—The use of mercury was formerly carried to an unwarrantable length.
Excessive use of mercury by no means a preventive of secondary symptoms.
In Sweden, prior to 1814, mercury largely used in primary syphilis;
average number of secondary afiFections of bones, M per cent. After 1814,
use of mcrcui-y more limited ; number of diseased bones reduced to 6^ per
cent.
Two kinds of chancres, indurated and non-indurated ; former heal much
more rapidly with mercury. Sore not cured properly if hardness remain.
Many sores which appear to heal rapidly under simple treatment leave
behind indurations. Evidence of medical officers during last peninsular
war shows, that all sores are curable without mercury; proportion of
secondary symptoms where mercury used, 1 in 7o, where none exhibited,
1 in 10 ; that all the secondary forms of syphilis may be cured without
mercury ; tliat secondary symptoms under such circumstances are unusu-
ally mild ; that unless when indurated, primary sores healed as rapidly
without as with mereury. But all admit that there are some sores which
can be healed in a few weeks with mercury, which would require as many
months without it.
With regard to iodine, Dr Wallace states, that it is heroic precisely in
those forms to which mercury is least suited. Ricord states, that where
mercury ceases to be useful, the hydriodate of potass proves the most
valuable and efficacious remedy ; but there are mixed cases of secondary
and tertiary symptoms where a combination of the two is required.
2rf, Comparative value of mercury and iodine in the treatment of the dif-
ferent farms and stages of syphilis,'-^As a general feet it may be stated, that
a modified mercurial treatment is applicable to the primary and secondary
foima, while the hydriodate of potass exerts the most undoubted effiict in
the tertiary.
According to Ricord, the characters which chancre display do not depend
on the specific cause which produced them, but on constHutional peculiar-
ities, mode of Uving, and the local treatment of the sore. In all simple
iraneties of chancre, as soon as they have assumed a quiet condition under
antiphlogisUc regimen (if they do not heal quickly without ferther assist-
ON THE TREATMENT OF SYPHILIS. 283
ance)y we should liave recourse to a mild mercurial course, and to its local
application^ not so much to^promote as to hasten cicatrization^ and to pro^
tect the constitution.
The danger of secondary symptoms is in direct ratio to the duration of
the primary ones, so that that mode of treatment should be adopted by which
they are found to be most speedily cured. In the first stage we have to do
with a specific sore, both irritable and poisoned, as well as itself poisonous^-
readily ulcerated by remedies ; while in the second we hayc a simple ulcer
destitute of all these traits. If mercury, short of salivation, fails to produce
a cure, it should not be persevered in ; but hyd. of potass with sarsaparilla
be given instead, though it seems to exert but little influence over them.
Indurated Chancre. — ^The advantages of a full mercurial course in this
form is clearly proved by the united testimony of all the best modem
authorities. It should be continued until the sore is healed, and alt indura-
tion of the cicatrice has disappeared. This does not apply to those cases
where the induration has been produced by improper applications (which
are to be distinguished by the inflamed as contrasted with the livid or
white areola), unless the induration persist after antiphlogistic treatment
has been employed, and the inflammation has yielded.
Phagedenic Chancre. — Most authors concur in thinking that as a general
rale mercury should .not be used in this variety, though occasionally it is a
valuable remedy. Dr Wallace, by whom Dr Hocken is chiefly guided,
divides these cases into nine varieties — a division which he regards as prac-
tical, and on which he founds his rules of treatment.
WiUioui Stoagh. With White Slough. With Black Slough.
1. Simple. 4. Simple. 7. Simple.
2. Inflamed. 5. Inflamed. 8. Inflamed.
3. Irritable. 6. Irritable. 9. Irritable.
In the 1st variety, mercury — ^unless it has been previously employed —
in that case mineral acids with sarsaparilla, and topical mercurial applica-
tions with fumigations. In 2d variety mercury should not be given till
chancre has put on healing characters. In 3d variety always injurious—
hyd. of potass with opium beneficial. In 4th, always beneficial, though
sometimes produces febrile mercurial irritation, when it should be given up.
In 5th, antiphlogistic treatment and large doses of mercury, ^which should
be discontinued if slough becomes dark. In 6th, if given at all, should
be combined with large doses of opium, and an anodyne local treatment.
7th, Not till sore puts on a healing character, when it hastens cicatrization,
and then very cautiously, from susceptible state of system. 8th and 9th,
Mercury decidedly contra-indicated ; where there is fever and excitement,
free bloodletting, &c. ; but where there is constitutional cachexia and de-
bility, hyd. potass, with opium and sarsaparilla internally, with local anti-
^logistics.
Worts and Fungi. — If irritable, must be quieted before having recourse
to stimulant applications. When indolent, wash with dilute llq. chlorid.
sodtt) then dust with calomel. In a variety which is flat or rounded and
comparatively even, mercury of striking utility ; Dr Wallace has never seen
it resist mercurial treatment.
Bubo. — Hunter was of opinion that their resolution depended upon the
quantity of meieury that could be made to pass through them. Dr Wallace
held similar views. Primary syphilitic bubo may be resolved in 99 cases
oat of 100, if mercury be properly employed, and its operation assisted by
rest, abstinence, laxatives, and cooling lotions, Dr Hocken coincides in
284
ON THE TRBATMENT OF SYPHILIS.
this, but thinks it should not be employed where acute mflammation exists,,
or where patient is plethoric, until tliis has been reduced by rest and blood-
letting. Locally, on Malapert's plan, of great use both in first stage and
after suppuration. Remove epidermis, and apply for two hours with a
bandage a piece of lint soaked in a lotion of hydmrg. bichlor. ^Jm aquc
distill, ^j. An eschar follows, which must be treated on common suigical
principles. In chronic bubo, friction with ioduret of mercury ointment
(hyd. proto-iod. '3j., adip. §j.) or compresses soaked in tr, iodinii gj^ aque Jii.
Open or ulcerating buboes to be treated on the same principles as primary
chancres.
Constitutional Syphilis, — Dr Hocken adopts the division into secondary
(attacking skin, mucous membranes, eyes, testicles) and tertiary (tuberoles
of skin and cellular tissue, affections of the bones, periosteum and fibrous
tissue, &c. &c.) ; in both of these mercury and iodine are requisite. As a
general rule, Dr H. regards the mercurial treatment as best adapted for the
secondary ; the treatment by hyd. of potass for the tertiary group.
All the diseases of the skin reqiiire antiphlogistic treatment in the early
stages, and then yield in general either to a mercurial treatment or that by
hyd. of potass.
Skin diseases we shall class in two groups, according as they are most
benefited by mercury or by hyd. of potass, remarking that in none is mer-
cury to be used during the acute stage.
Hyd. of Potass.
Vesiculff. ) Nutritious Diet
Bullae. j Opium.
Pustule. When severe, as above,
and
Mercury.
Papule. (Also weak lotions of cor-
rosive sublimate locally.)
Squame. (Locally — ung. hyd. nit.-
ox. or sol. bichlor. hydrarg.)
Exanthemata.
-FwMre*.— Mercuiy. [In these we have found great benefit from araenic,
where both mercury and iodine had failed.]
Condylomata,-— V^q;^! with dilut. solut. of chlor. of soda, and dust with
calomel ; mercury internally.
Affections of Mouthy Throaty and Nostrils. — ^AU the simple sores, when
brought into a healthy condition, are beneficially influenced hy mercury.
Sloughing sore throats should be treated antiphlpgistically, when the patient
can bear it ; when occurring in broken-down constitutions, with iodide of
potass, sarsaparilla, and opium. When the ulcer has taken on a healing
action, cicatrization is promoted by mercury.
Tertiary Symptoms.— -Mercury inefficacious. Hyd. of potass beneficial,
especially in diseasts of the bones, fibrous tissue, and joints ; also in early
stage of disease of bones of nose, palate, or face. The ung. hydraig. nit.-
oxid. may be used locally.
Syphilitic Tubercles. — ^In indolent syphilitic tubercles, a combination of
iodine and mercury may be employed. (Ricord's formula was one of the
followmg pills daily, on the fifth day two pills are given ; the mercury is
soon dropped, and the treatment concluded by hydriodate of potass : Hyd.
proto-iod. gr. j. ; ext. conii gr. v. ; pulv. opii gr.'ss.)
The next part of Dr Hocken's paper is devoted to the method of em-
ployment of mercury and iodine, and is so meagre, that we shall substitute
for it an abridgment of the views of Desruelles^ CuUerier, Ricord, Biett,
and the other authorities in this disease, with a selection of the formulc
employed by them. Calomel is chiefly employed when a speedy and
iwwerful efllct L$ required.
J
ON THB TRBATMBNT OF SYPHILIS. 285
Bidihnde of Mercury is strongly recommended by Dzondi and Dupuy-
tren, chiefly for the treatment of constitutional symptoms. The fbrmer
began by giving one-fifth of a grain, and increased it so that in thirty days
the patient took a grain and a half. Dupuytren was of opinion that small
doses were more efficacious than larger ones ; he rarely exceeded the sixth
of a grain for a dose, usually giving one of the following pills three times
a- day. B». hydraig. bichlorid. gr. ii. ; pulv. opii gr. viii. ; gum. guaiaci Sss.
M. ft. pill. xvL*
PiU, Hydrarg^ — The action of these is well known, and they are perhaps
as good a remedy as we can employ ; pills made of mercurial ointment as
recommended by Sedillot are milder, and sometimes agree better with the
stomach.
'Ql, Ung. hydrarg. fort. 3i. ; sapon. Hisp. 9ii. ; pulv. althee et
mucilag. q. suff. ft. pill, xxxvi. gr. iv. in singulis ; ii.-iii. quotidie pro dose.
Proto-Ioduret. — It is especially useful in secondary syphilis, tubercles,
and exostoses. The following is the formula of Cullerier. R. hydrarg.
proto-iodureti gr. xii. ; pulv. opii gr. vi. ; gum. guaiac. 3j. M. ft. pill. xxiv.
Iodine, — Dr Wallace found the hyd. of potass to agree better than pure
iodine. Ricord begins with ten grains daily, and in divided doses, and
gradually increases it.
Dr Hocken concludes with a review of the comparative merits of the
remedies, and his conclusions are as follows : —
1. That mercury and iodine are the two main remedies for the treat-
ment of syphilis.
2. That neither is a specific, and neither can be used empirically..
3. That mercury is adapted to nearly all the forms of primary syphilis,
especially to the indurated.
4. That in constitutional syphilis, it is applicable to a great majority of
the secondary, but either hurtful or useless in the tertiary.
5. That iodine is inert in almost all the varieties of primary syphilis, with
the exception of some forms of phagedsna ; that it is less valuable than
mercury in the secondary class, except in cases of a hectic and debilitated
constitution ; that in tertiary symptoms it is more valuable than mercury.
6. That mercury and iodine are advantageously combined in cases pre-
senting a combination of secondary and tertiary diseases.
7. That when mercury is employed, the mildest constitutional effect
capiible of overcoming the disease should be preferred.
8. That the only form of iodine applicable is the hyd. of potass, which
should be given in moderate doses.
9. That, however valuable hyd. of potass may be in certain forma. It
never can be substituted for mercury in the treatment of syphilis.
MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN*
Risk Qitending an Tnjeetums into the Uterine CutUy.
In a case of floor aUras^ Hoormaon observed that immediately on injeetinig
a deooctioa of walnat leaves into the nterus the patient eomplaUwd of
* The ejanutttiMfntfaeoajambadtmtedCtriU
soluble, and not so entlj deeomiMMed, seeing mofe qnlMf, sad vidMWt fndm^ng
paiiM 0t Ae stewaffc . 1^ Hj&mt^ efmutnd gr, xsir, ; mbommiu mwiiaL iuL ;
giuiaci gum. JfiL ; cxC aoMihi 3iiL ; <C aiM K^ xxiv. M. nudfafp ^ s. vcft.
piU. Goec Oae sr two mice tfr tkffw ciflMa a^di^^ i;»»diiall|r iflocMifig
286 USE OF THE TAMPON.
violent pAin in the nbdomen, and an attack of metroperitonitis'enBaed which
required energetic treatment for its removal. Examples of the same result
of injection occurred twice to Bretonneau, who presumed that the disease
arose from the injected fluid passing through the Fallopian tuhes into the
peritoneal sac. He found that on injecting copiously and forcibly into the
uterus of the dead subject, in two experiments the fluid passed through
the Fallopian tubes ; in one the injection returned through the uterine
vessels (!), and in six it repassed between the syringe and the cervix uteri.
'-'Schmides Jahrb. B. 80, S. 41.
Use of the Tampon for the Cure of Utero-Vaginal Blennorrhtta,
HouBMANN afiirms that the irritation excited by the secreted matters often
keeps up the flow ; he therefore considers it advantageous to separate the
sound from the diseased parts in order to keep off the morbid secretions,
and for this purpose he has found plugging the chief, and in some instances
the only, means of cnre. The author recommends the tampon to be made
of charpie, if it is to be placed high in the vagina, but as soon as the parts
can be kept dry, this material is to be changed for prepared wool, which can
be introduced by means of a ** porte-mSche," in larger or smaller dos^ls, so
easily as to be done by the patient herself. Thirty-eight cases of blennor-
rhoea of different kinds have been treated in this manner with the most
complete success. The tampon has been resorted to in females of all ages,
and even in those in whom the parts were in a high state of inflammation.
In these latter cases, and where the person was very young, the plug was
slightly smeared with oil. If the flow was very copious, the cotton was
changed twice a- day. No injections were required, the most essential
point being to keep the parts as dry as possible. The same treatment was
adopted and proved successful in blennorrhcea of the rectum. — Schmid^i
Jahrb. B. 31, 8. 834.
Trismus Neonatorum treated toitk Mutk*
An epidemic, trismus neonatorum^ has been recently observed by Cderach-
jold in the lying-in hospital at Stockholm, and Levy in the Freidrich's
hospital at Copenhagen. Of 22 cases in the practice of the latter, 20 died ;
in 15 a post-mortem examination was made, and in 14 inflammation of the
nmbilical arteries was observed. In general both arteries were affected,
especially in that part of their course which runs along the sides of the
bladder ; the peritoneum in their neighbourhood was strongly injected.
The canals of the vessels were dilated, and filled with a dark purulent fetid
matter ; their parietes were frequently adherent to the omentum or intes-
tines, and appeared somewhat thicker and darker than usual. In several cases
perforation of the vessels with efi^usion of pus into the pelvic portion of tbs
peritoneal sac was found. Thorston states that he has found the internal
administration of musk and the external application of the unguent, cine-
rcum highly useful. — Fricke und Oppenheim's Zeitschrift, Bft. 9.
Keirmiss Mineral in Pkuro-Pneumonia in Children,
GuGRSAMT has found that in this disease the frequency of the pube and
inspiration, and the severity of the local symptoms^ are gradually diminished
by the use of the kermes mineral, given in doses of from two to tliree gnuiMS
CHANGES IN RAIN-WATER. 287
tliree or four times in twenty*four hours, for children five or six years old,
-Journal fur Kinderkrank, B. i. Eft. 2.
On Testing the Qualities of a Nurse^s Milk.
Deveroie, inspector of the institution for nurses in Faris^ has given his
conclusions as to the quality of the milk in reference to its microscopic
characters. The milk of the human female contains corpuscles of three
different sizes. That which contains the lai^est globules is the m^t nutri-
tive, but milk containing those of a moderate size is the most frequently
met with. The milk with large globules is found chiefly, though not
without exception, in wompn of the sanguineo* lymphatic temperament.
There is sometimes a remarkable difference between the milk of the two
breasts, which it appears often depends on the child being permitted to suck
the one breast in preft^nce to the other. When the milk of one nurse is
found not to agree with a child, the microscope may be of use in determin-
ing whether or no the milk of a second is not apparently of exactly similar
quality ; but there are many changes which it undergoes that the micro-
seope cannot show. — Gastette M^tcaky Fevrier 1844.
FORENSIC MEDICINE AND MEDICAL POLICE.
Meam of Correcting the Changes which take place in Rain -Water kept in
Cisterns newly constructed with Lime. By M. D'Arcet.
A niopRiETOR in the country, who had no other water but tliat obtained
£^>m a bad draw-well, determined to erect a cistern which should receive
ail the rain-water that dropped from the roofs of his houses. The cistern
vas accordingly built of stone, and lined with tiles united by mortar. In
process of time the cistern was filled, but the water which was taken from
it had a greenish tint, and was so charged with lime, that animals refused to
drink it, and it could not even be used for watering flowers or shrubs, as it
lefi; them covered with a white coating. M. d'Arcet was requested to give
his advice, as to how these changes in the water could be prevented. He
recommended the cistern to be emptied and sponged, to render it as dry as
possible, with the view of saturating the lime with the lees of oil, hot
linseed oil, or some other fatty composition, according to the method which
we are told by Vitruvius and Pliny was pursued by the Greek and
Roman architects. M. d'Arcet, however, found on descending into the
cistern, that the lime was so saturated with water, which continued to
distil from it drop by drop, that it was in fact impossible to dry it
fluificiently for the purpose ; he therefore relinquished this attempt, and
resolved to endeavour to convert the lime into a carbonate, and thus render
it unaasailable by water. A small brick furnace was erected in the cistern,
in which a hectolitre of charcoal (6105 cub. in.) was burned every day
for a week, the cistern being kept nearly closed during the day, but freely
exposed to the air at night. A few grains of the lime were scraped off
^ly, fi»r the purpose of examining what change had taken place in it ; in
less than eight days, it was found that the water with which it was
mingled no longer pre3cnted the characters of lime-water, nor decomposed
the muriate of ammonia ; for further secarity, however, the charcoal was
burned in the cistern for a week longer ; at the end of that time it was
thofoughly cleaned out, and when filled with rain-water, \he fluid was
foond sufficiently pure to serve for experiment at the laboratory of the
Royal Mint instead of distilled water. An instance exactly similar to the
288 MEDICAL MEMORANDA.
preceding is mentioned by the same author, where, for the purpose of
correcting the water, twelve kilogrammes (about 28 pounds) of animal
charcoal were thrown into the cistem ; this had the desired effect, and
four years thereafter, without the charcoal being renewed, the cistem still
furnished water sufficiently good for all domestic purposes. — Annaks
d'Hygiene, Ayril 1844.
Part IV.— MEDICAL MEMORANDA.
On the Time required for the Transit of Coins and the like through the Intes-
thiesy when swaUowed accidentally.
As parents, and even the junior members of the profession, are apt to be
alarmed by children accidentally swallowing objects which are given to
amuse them, such as pebbles, leaden bullets, coins, &c., should you consider
the following communication to deserve a place among your memoranda, it
may perhaps be the means of quieting the apprehensions of those who may
be called, and have not previously been concerned, in such cases.
On the 2d of June of the present year, I was hurriedly sent for by Mr
M., who became much alarmed in consequence of one of his children, a
boy three years old, having swallowed a farthing. As I was informed that
after the coin had disappeared the child had no cough nor difficulty in
swallowing, I was satisfied that the foreign body had passed into the
stomach, and that it would in due time be. evacuated from the bowels
without any detriment to the little patient. Of this, however, the parents
were not a little sceptical, and became anxious lest the detention of copper
in the body might prove deleterious. To allay their apprehensions, there-
fore, some infusion of senna was administered to the child every third
morning to accelerate the expulsion of the coin, which happened on the
seventeenth day of the same month. When swallowed it was quite bright,
but after its expulsion it was of a dark colour. It is unnecessary to state
that there was no uneasiness complained of during its detention. Pending
the transit of the farthing in the present case, two other instances were re-
lated in which each of the children swallowed a similar coin ; but, unlike
what had occurred in the first child, in each of the latter the farthing was
evacuated on the thii*d day. Some time previously each of two other
children, about the same age, swallowed a half-sovereign, which in both
instances was retained for three months. Dr A. T. Thomson I'elates two
cases in which lai^e coins had been swallowed ; one of these was that of a
boy, who swallowed a penny piece, which did not make its appearance for
six months thereafter ; the second was a younger boy, who also swallowed
a similar coin, but, unlike what happened in the first instance, it escaped
after two months' detention. In both instances the coins were much
eroded, but they exerted no injurious effect on the health of the children.
Dr Paris mentions a case in which, with a suicidal intent, six penny pieces
were swallowed, and they remained six years in the intestines ; and Dr
Baillie records a case in which, on dissection, he found embedded in a pouch
in the stomach a coin which had been swallowed soi^e considemble time
previously. Wjf*'tJAMPBELL, M. D.,
Lecturer on Midwifery, &c.
12th July 1844.
Printed by OUver ii Bojd, Tweeddale eonrt, II I gh Street, Bdii>borgh. ^
(
THE
NORTHERN
JOURNAL OF MEDICINE.
No. v.— SEPTEMBER 1844.
Part I.—ORIGINAL ARTICLES.
Case of suspected Poisoning by an Over-dose of Tartar Emetic,
sent ovt by a Non-professional Dispenser. By Ebenezer
Skae, M. D., of Leven, Fifeshire.
The following outline of a case, in which death was suspected to
have been occasioned by an over-dose of tartar emetic, besides
presenting some features of interest in a toxicological point of
view, appears to furnish a very striking example of the disas>^
trous consequences which are calculated to result to the commu-
nity, from the dangerous but too prevalent practice pursued in
this country, by individuals undertaking the retail and dispensing
of drugs possessing the most energetic and potent qualities,
without their having received any competent instruction on the
nature and properties of therapeutic agents, and who are conse-
quently in a state of comparative ignorance, both as to their
uses, and the doses in which they can be safely administered.
To what extent an enlightened and a professedly philanthropic
le^lature is responsible for the continuance of a practice fraught
with such serious contingencies, it is not my present object to
inquire.
On the morning of Friday the 21st of January 1842, about
three o'clock a. m., I received a hurried request to visit J. J.,
who resided within a short distance of me, and who, I was
informed, was to all appearance expiring. On my arrival at his
dwelling, a few minutes afterwards, I found that he was dead.
He was a man of short stature, of robust habit of body, and
about forty-five years of age. The external aspect of the body
presented nothing remarkable, with the exception of a tumefied
and congested appearance of the integuments of the face and
neck, and considerable distention of the abdomen. On making
some inquiry regarding the nature of the symptoms which had
preceded death, the statements I received from the family were
far from being intelligible and satisfactory as accounting for the
2o
290 CASE OF SUSPECTED POISONING
cause of death. My judgment of the case, indeed, rested on a
knowledge of the following facts, some of which had been a
matter of personal observation to me in the course of my former
professional attendance on the deceased, and the rest were com-
municated to me by his family.
For several years, at a previous period of his life, he had been
much addicted to the intemperate use of alcoholic stimuli, during
which time he was repeatedly under my care, in consequence of
his having been affected with attacks of delirium tremens; but
four years previous to his death he had joined the Total Abstin-
ence Society, and I had reason to know that, up to the last week
of his life, he maintained habits of the strictest sobriety. On
" Old Hansel Monday," which is invariably observed throughout
Fife as a holiday, especially among the working-classes, and
which occurred that year on the 17th of January, being the
Monday of the same week in which he died, he unfortunately
broke through his good resolutions, and foolishly indulged in the
use of liquor till he became intoxicated ; on Tuesday and Wed-
nesday he continued his debauch ; on Thursday morning at ten
o'clock, feeling himself suffering greatly from the usual effects
of intemperance, he sent for an emetic and took it, as had been
his former practice under similar circumstances, when he had
always experienced considerable relief by its employment. The
action of the vomit commenced eight or ten minutes after its
exhibition, and was stated to have been powerful, which was
followed about two or three hours afterwards by profuse
diarrhoea, and this latter symptom continued with little inter-
mission up to the moment of dissolution, which took place six-
teen hours after the emetic had been administered. During the
latter part of the day, he had complained very much of pam in
his throat and in the region of the stomach, and he appeared to
labour under great general uneasiness and restlessness, with oc-
casional sweatings and great prostration of strength. He had
been very fretful under his sufferings, and had incessantly im-
portuned his wife and family to send for my assistance, which
they had as steadily refused or evaded, from a belief that his
complaints were of the same nature as he had formerly endured
from similar causes, and that they would gradually abate, as they
had frequently done on previous occasions. At length his im-
patience to see me had become so strong, that he declared he
" would go to the doctor himself;" and by an unexpected exer-
tion of his own strength, he contrived to slip out of bed, when
he almost instantly fell prostrate on the floor in a state of insen-
sibility. On this his wife and family immediately alarmed the
neighbours and sent off for me. On replacing him in bed, life
appeared to be extinct ; a fact but too evident to myself on my
arrival a few minutes afterwards.
On carefully considering these circumstances, I experienced
BY TARTAR EMETIC. 291
great difficulty in forming a satisfactory conclusion as to the
character of the symptoms which had resulted fatally in this
case. From all that I could learn^ I had no reason to believe
that the characteristic phenomena of delirium tremens had been
present during life. That any serious lesion of an apoplectic
nature had taken place within the cranium, appeared at least
as improbable, from the leading features of such a seizure having
been absent in the case. There had also been an entire absence
of any indications that could lead me to suspect the existence of
any thoracic disease of a rapidly fatal nature. The train of
symptoms appeared to imply a strong probability that the seat
of the disorder was in the abdominal viscera, and moreover
that the disease might have been enteritis; at the same time, I
could not divest my mind of a suspicion that the effects of the
emetic had some connexion with the morbid phenomena, which
had been developed subsequently to its administration ; — ^a sus-
picion, indeed, which was in the first instance suggested to me
by the language of the widow of the deceased, who, in reply to
my question as to how the vomit had acted, stated that it had
done so very powerfully, and that " he/' to use her own words,
" appeared never to have got above it." Under the influence
of this impression, I was naturally led to make some inquiry re-
garding the appearance of the einetic which had been given, and
also where it had been purchased ; when I was informed that it
had been obtained from a grocer's shop where drugs of different
kinds were sold, and that it consisted of a white powder, of a
similar bulk to that of the brmun vomits thejr had formerly been
accustomed to get from the same shop. This information led me
at the moment to infer, either that the vomit in question had con-
sisted of sulphate of zinc in powder, or that possibly, from some
mistake, an overdose of tartar emetic had been sold by the grocer's
shopkeeper who had supplied it. As the family, and especially
the widow, appeared to attach considerable suspicion to the vio-
lent action of the emetic, inquiry was made the following day at
the shop where it had been purchased, when the shopman at
once admitted, in terms exhibiting no small degree of confidence
in his own knowledge of such matters, that he had supplied them
with two drops or ahout fifty-five grains of tartar emetic as a
safe and proper vomit.
On the 28th of the same month, in consequence of a warrant
from the sheriff, the body was disinterred for the purpose of ex-
amination, which Dr Grace of Cupar and myself were requested
to make, and thereon report. As I find I have mislaid my copy
of the report which we drew out and submitted on the case, I
shall content myself with giving here a statement of the leading
facts embodied m it, as I have thenl recorded in my note-book.
The integuments of the face and neck were of a dark purple
colour, those of the body generally exhibiting indications of in-
292 CASB OF SUSPECTED FOISONINU
cipient decomposition. There was an oozing of sero-sanguineous
fluid from the nostrils which discoloured the cloths. On exposing
the contents of the cranium, the vessels of the investing mem-
branes presented a congested appearance, and in the ventricles
and sinuosities of the brain there was some serosity. The sub-
stance of the brain itself appeared healthy.
On laying open the pharynx and oBSopha^s, the mucous
membrane of the former and the superior portion of the latter
strikingly indicated the existence of inflammatory action during
life, from its dark, discoloured, and injected appearance. There
was no effusion of serum within the thorax; the lungs were
somewhat congested, free of adhesions to the walls of the chest,
and otherwise nealthy. The heart was full-sized, but not hyper-
trophied, and perfectly normal in all its valvular apparatus, its
right cavities containing dark semifluid venous blood.
On opening the cavity of the abdomen, there was found serous
effusion to the extent of from two to three ounces. The lining
and investing membrane presented nothing unusual in its appear-
ance. After laying open the stomach, we found that its mucous
membrane was softened, and loosely adherent to the submucous
tissue, being easily scraped off with the point of the finger.
While no circumscribed discoloured patches were observable,
still the viscus presented a highly vascular appearance, especially
in its greater curvature, and continued along a considerable por-
tion of the duodenum. The rest of the ahmentary canal ap-
f)eared comparatively healthy. A considerable quantity of a
ight brown, thick, and homogeneous fluid was contained in the
stomach, and was found more or less in quantity throughout, the
whole length of the intestines ; which, it may be here remarked,
corresponded in character with that of the dejections before
death. The contents of the stomach were collected and set aside
for analysis, and the stomach itself was removed and preserved
in spirits. The Uver presented some marks of disease of long
standing, evidently the result of the former intemperate habits
of the deceased. The spleen, kidneys, &c., were not particularly
examined.
After filtering the fluid which had been contained in the sto-
mach, it was tested by means of lime-water, tincture of galls,
and sulphuric acid. The two former, when added to the fluid,
produced in a faint degree their characteristic precipitates ; that,
however, produced by the addition of sulphuric acid was very
satisfactory, and was taken up again when the reagent was added
in considerable excess.
From the character of the symptoms which had been exliibited
before death, as far as our information enabled us to judge, — ^from
the suddenness of their fatal termination, — ^from the appearance
presented by the pharynx, gullet, stomach, and duodenum, — firpm
the evidence of the presence of tartar emetic in the contents of
BY TARTAR EMETIC. 293
th« stomach, indicated by the reagents employed, and especially
by the sulphuric acid, taken in connexion with the fact admitted
hy parties, that fifty-iSve grains of tartar emetic had been ad-
ministered to the deceased previous to the accession of the urgent
symptoms which resulted fatally in sixteen or seventeen hours
after its exhibition, — we felt convinced, without any additional
proof derived from a more elaborate chemical analysis, that
death had been occasioned by a poisonous dose of tartar emetic,
and accordingly gave this as our opinion of the case.
The stomach having been removed and preserved in spirits, as
already stated, I subsequently deemed it desirable, both for my
own satisfaction and for legal proof, if necessary, to institute a
more extended analysis of the menstruum in which this viscus
had been contained. The stomach was removed after being
well bruised in the fluid, a small quantity of which was then
tested by means of sulphuric acid, which produced and took up,
when added in excess, the characteristic precipitate. The re-
maining portion of the fluid was then acidulated with muriatic
and tartaric acids, and, according to Dr Turner's process, was
submitted to the action of a stream of sulphureted hydrogen,
when the peculiar orange-red sulphuret of antimony was preci-
pitated. This was next carefully collected on a filter, dried, and
placed in a tube through which was transmitted a stream of hy-
drogen, while the flame of a spirit-lamp was made to play around
that portion of the tube containing the sulphuret. On breaking
the tube, it was found internally to be coated with a metallic-
looking crust, from which I inferred that the hydrogen had been
transmitted with too great rapidity. To procure the metal, if
possible, in a more satisfactory form, the fragments of tube were
submitted to the action of nitric acid, and the sulphuret was
again precipitated, collected, di^ied, and subjected as before to
the action of hydrogen, which was this time slowly and cautiously
transmitted. On afterwards breaking the tube, metallic anti-
mony in minute shining particles was found within it.
The grocer and his shopman having been indicted for culpable
homicide, the case was brought forward at the spring circuit
court of that year at Perth ; but, in consequence of objections to
the relevancy of the indictment having been entered by the
counsel for the panels, the consideration of these was adjourned
to the High Court of Justiciary in Edinburgh, where they were
subsequently considered, and unanimously repelled ; in conse-
quence of which the parties were again indicted to stand their
trial at the autumn Perth circuit. When the case was called,
however, the public prosecutor stated that, for various reasons,
he did not intend to bring them to trial. Their excellent char-
acter, their deep regret for the unfortunate mistake, the entire
absence of criminal intention, the probability of death having
been accelerated by other causes than the tartar emetic, and the
salutary effects of giving the case sufficient publicity being already
294 CASE OF SUSPECTED POISONING
gained, were stated as the principal grounds on which he dropped
the prosecution. The accused were then dismissed after a forcible
admonition from the bench, when such dangerous practices were
censured in the strongest terms.
In shortly adverting to the leading features of the preceding
case, with the yiew of comparing these with what has been
already ascertained as characterizmg the action of antimony in
poisonous doses, and the morbid appearances presented sater
death, an important consideration must not be overlooked as a
necessary element in forming a just solution of the question, and
that is, the very scanty materials which we already possess as
data to enable us to arrive at a satisfactory conclusion on the
subject. The number of parallel cases on record, as far as I am
aware, is but small, and even these few do not altogether corre-
spond in their details. The phenomena attending the action of
the drug, however, when administered as a therapeutic agent,
are sufficiently well known, and these would naturally lead us to
expect that urgent sickness and vomiting, followed by trouble-
some diarrhoea, would be most constantly and prominently exhi-
bited among the effects produced by it wnen taken in a poisonous
dose, and retained sufficiently long to admit of its absorption and
constitutional action ; nor are we deceived in such an expectation,
for in almost every such case on record it will be found that these
symptoms have been uniformly present to a greater or less ex-
tent. Professor Christison, in his invaluable work on poisons,
quotes, among other cases which illustrate the constancy of these
symptoms, one which exhibited a very striking resemblance to
cholera, which, besides being characterized by pain in the sto-
mach, vomiting, coUc pains, diarrhoea, small contracted pulse, and
great prostration of strength, was attended with <&8tressing
cramps in the legs.* In other cases we find that, in addition to
the vomiting and diarrhoea, a cold clammy state of the skin,
swelling of the abdomen, hiccup, tremors, convulsions, and de-
lirium, have been the attendant symptoms.
About nine years ago I had an opportunity of observing the
symptoms produced by a poisonous dose of tartar emetic, in the
case of a child from eighteen months to two years of age. I
had occasion to employ it as an external counter-irritant in the
form of ointment on another member of the family. The
mother had imprudently laid aside the box containing it, in a
situation within reach of the child. On being sent for, I found
the mother in a state of the greatest alarm about her boy, who
certainly appeared to be in a very dangerous condition. His
features had that pinched collapsed appearance so characteristic
of cholera, the eyelids were half unclosed and the pupils turned
upwards, the extremities were cold, and the cutaneous surface
was bedewed with a clammy moisture ; the pulse was small and
* Christison on Poisons, p. 448.
BY TARTAR EMETIC. 295
tliready and increased in frequency ; there was incessant diarrhoea,
with occasional distressing attacks of sickness and vomiting, the
ejected matter being of a very bilious character. The box con-
taining the ointment was put into my hands, and the mother
stated that she had taken it from the child while he was in the
act of licking his fingers, the marks of which were imprinted on
the ointment contained in it ; soon after which he became affected
with the sjrmptoms under which he was then suffering. De-
coction of cinchona was immediately prepared and exhibited in
small and frequently repeated doses, and within a few hours I
had the satisfaction of finding an amelioration of all the symptomSi
which was eventually followed by complete recovery.
In addition to the symptoms above alluded to, Magcndie was
led to conclude, from experiments on animals, that the poisonous
action of tartar emetic was uniformly characterized by inflamma-
tion of the pulmonary organs ; but as Professor Christison has
justly observed, the circumstance of such symptoms having been
absent in all the cases on record, implies the probability of some
fallacy in these experiments. It is important to remark, how-
ever, that the inference drawn by Ma^endie from his investi-
gations, viz., that death is produced in poisoning with tartar
emetic by its absorption exciting a general inflammatory state
of the whole system, derives considerable confirmation from the
fact of its harmonizing with the result of similar investigations
conducted by other individuals. If this view of the subject be
well founded, which is not improbable, it may be assumed that
the uniform and prominent indications of gastro-intestinal irrita-
tion are essentially characteristic of the poisonous action of the
drug, while the other accompanying symptoms may be regarded
as additional features of its general irritant effects, more or less
modified by contingent or constitutional causes.
From the circumstance of J. J., the subject of the case under
consideration, not having been seen during life, it is evident that
the statement of his symptoms contained in the preceding out-
line must in several respects be regarded as imperfect ; these,
however, as far as thev were ascertained, do not appear to have
exhibited any material difference from those of other cases on
record. As in them, so in his case, there were present the
leading characteristic irritant effects of the poison, indicated by
pain in the throat and epigastric region, and by vomiting and
diarrhoea. Cramp in the legs was not stated to me as having
been complained of; but as this symptom is probably in such
cases as much symptomatic of irritation in the stomach and
bowels as it is in similar states of derangement produced by
other causes, its invariable presence does not seem to be a
necessary accompaniment of the poisonous action of tartar
emetic. Hiccup, convulsions, and delirium were not specified as
having been among the features exhibited in the CQ»e ; but these,
it may be observed, do not appear to have been uniformly
296 CASE OF SUSPECTED POISONING.
present in the other cases on record ; such symptoms conse-
quently, more especially the two last, may be fairly considered
as indicating the narcotico-acrid action of the drug on the brain
and nervous system, which may be of variable intensity m
different cases, and whose indications may be more or less modi-
fied by constitutional and other causes. In the absence of these
symptoms, however, there were others exhibited of a character
which denoted not merely great prostration of the general
strength (a feature strikingly marked in the case quoted by
Dr Christison and formerly alluded to), but also excitement and
exalted irritability of the brain and nervous system, indicated
by the general uneasiness and intolerable restlessness of the
sufferer, and expressively manifested by his peevishness and the
irritable state of his temper.
In reference to the post mortem appearances exhibited by the
case under consideration, I shall merely remark, that they
correspond very nearly with those stated to have been observed
in the case of M. Recamier, which is quoted by Dr Christison,
and which, as far as I know, is the only authentic instance on
record of the necroscopic appearances produced exclusively by
the poisonous action of tartar emetic.
In concluding these brief observations, I must advert to a
circumstance of no small importance, which ought to be taken
into account in forming an estimate of the poisonous qualities of
tartar emetic, and that is, the fact of its activity being greatly
modified by the state of the body at the time it is administered.
The extent, indeed, to which it has been given as a medicinal
remedy, especially in the treatment of pneumonia, would lead us
to entertain considerable doubt regarding its activity as an
irritant poison. But while this consideration should not be
overlooked as an important element in the question, it must also
be kept in mind, that the action of other therapeutic agents is
influenced by laws of an analogous nature. It is well known,
for example, that in some diseases, opium may be safely admin-
istered to an extent that would prove poisonous in the absence
of those symptoms for which it is exhibited. Such a peculiarity,
however, in the action of tartar emetic, does not appear to me
to weaken the evidence of poisoning in the case of J. J. That
condition of the system which usually forms the sequel of a
debauch is unquestionably characterized by weakness and de-
pression of the powers of life, accompanied with much general
irritability, especially of the brain and nervous system; and
these indications bear no remote resemblance to the symptoms
attending the constitutional action of the drug in a poisonous
dose. Hence, so far from such a state of things tending to fortify
the body against its baneful influence, there seems every reason
to conclude that the circumstance in question would materially
facilitate its destructive effects.
Leven, Fife, J^dy 27, 1844.
TRUL OF SAMUEL CLARK. 297
Tnal of Samuel Clark on a Charge of Murder by Stabbing
in the Vulva ; with Remarks By Willlam Tait, M. D.,
Surgeon to the Edinburgh Police,
Samuel Clark, weaver, was tried before the High Court of
Justiciary at E<hnburgh, on Thursday the 27th July 1843, for
murder ; " in so far as, on the 9th day of June last, within the
house in the West Port of Edinburgh occupied by Alexander
Gibb, lodging-house keeper, he did wickedly, maliciously, and
feloniously attack and assault Mary Peters or Clark his wife,
and with a knife or some other sharp instrument, or by re-
peated blows or kicks, had inflicted a severe and mortal
wound on her person, in consequence of which, or of the loss of
blood, or hemorrliage proceeding therefrom, the said Mary
Peters or Clark died that night, or early next morning, and
was therefore murdered by the said Samuel Clark."
The evidence against the accused was chiefly that of his
fellow-lodgers, his daughter, a girl too young to be put upon
oath, the lodging-house keeper and his wife. From this it
appeared that he and the deceased had been out begging
during the day, and had returned to their lodgings about eight
o'clock in the evening, both much intoxicated. A quarrel en-
sued, and blows were exchanged between them, but apparently
of a trifling nature. She was represented by one witness to
have been kicked, and this statement was corroborated by the
declaration of the deceased herself in the presence of the*
police-officers and several of the inmates of the house. This
was said to have occurred a Uttle after nine o'clock ; and before
this, the panel and his wife were observed, by a person in
bed in the same apartment, to be sitting opposite to each other
at the foot of their bed, apparently in friendly conversation.
It was at this time too dark to observe distinctly what was
going on, but the witness was certain that they were sitting
face to face. The foot of the one bed was only about eighteen
inches from that of the other, their heads being in the opposite
direction. Having fallen into a slumber, he did not know how
long they sat in that position, but was afterwards awakened by
Mrs Clark calling for assistance. On inquiry she stated that
Clark " had kicked her in the lower part of the belly, and that
she could not live." She immediately left the room and went
to the kitchen to seek some of the females who were in the
house. A light having been procured, a stream of blood was
observed along the passage from the kitchen-door to the bed-
room, and a considerable quantity on the floor of the room near
to the bed. The females, after examining her condition, were of
opinion that it was a case of flooding, and sent the landlord and
a lodger for medical aid. Clark himself having, during the
2p
298 TRIAL OF SAMUEL CLARK.
bustle, gone out of the house, did not return for some time.
Three medical gentlemen were called upon, but none would
attend. They returned home, and aU in the house went to bed.
No more was heard of the case till four o'clock next morning,
when the watchman on the station was informed that Mrs
Clark was dead. Bein? called upon officially, I immediately
visited the house, and found the body stretched upon the bed,
remarkably pale, and apparently without external injury.
There were clots of blood about the external organs of gene-
ration, but no bruise or other injury to confirm her statement
that she had been kicked. The bedclothes were hteraily
saturated with blood, and traces of it were still observable
upon the floor, although the keeper of the house had attempted
to wash it out. The uterus was much enlarged, and the out-
lines of a foetus could be distinctly traced through the parietes
of the abdomen. The impression produced upon my mind was,
that the woman had died from uterine hemorrhage, although I
did not in the presence of so many persons attempt to confirm
this opinion by an examination per vaginam.
In his declaration, Clark stated that his wife had not menstru-
ated for six months, and that she had informed him that she had
become unwell that forenoon. He denied all knowledge of her
being with child. If she had died from injury, it was unknown
to him, for he had neither kicked nor injured her in any way.
The body having been removed to the police-office. Professor
Simpson, Dr Graham Weir, and myself, made a post mortem
examination on the forenoon of the 11th curt., and prepared a
report, the substance of which was, — That there was no exter-
nal injury, with the exception of a spot of ecchymosis on the
external aspect of the left thigh. The brain and membranes
were healthy, but the blood-vessels and sinuses empty. The
viscera of the chest and abdomen were all healthy, although
more blanched than usual, and only about three ounces of blood
escaped on dividing the large vems and removing the heart.
The uterus contained a foetus apparently about the sixth month,
and the os uteri was impervious. " In the superior part of the
vulva there was an incised wound an inch and a quarter in
length, and at its inferior extremity a quarter of an inch in
depth. It commenced a quarter of an inch above, and passed
obliquelv downwards and inwards about two lines to the left of
the orifice of the urethra, and terminated within the vagina
under the arch of the pubis. On the surface of the wound there
were numerous orifices of blood-vessels of different sizes." From
the facts embodied in the report it was inferred, —
1st, That this woman was not affected with any natural dis-
ease which would account for her death.
2dy That the almost total absence of blood in the body war-
ranted the opinion that she died from hemorrhage.
TRIAL OF SAMUEL CLARK. 299
Sdy That she did not die from uterine hemorrhage, a possible
occurrence in her impregnated condition.
4«A, That there was no wound in any part of the body from
which blood could have flowed but that in the vulva.
5th, That this wound must have been the result of violence
inflicted with an edged instrument.
After reading the report as part of the medical evidence, I
underwent a very lengthened examination on the nature of the
wounds and probable mode in which it had been inflicted, and
particularly in reference to the possibility of its being suicidal.
On this latter question there was a slight difference of opinion
between Professor Simpson and myself; he having stated " that
it was very improbable/' and I " th^ it was so difficult as almost
to amount to an impossibility," My reasons for this opinion
will be stated in the remarks on the trial. On the other topics
embraced in the examination it is unnecessary to make any
observation.
Drs Allan Thomson and Douglas M'Lagan read each a
report ; that of the former having reference to a microscopical^
and that of the latter to a chemical examination of matter found
upon the blade of a knife produced in evidence, and found in the
prisoner's possession the morning on which he was apprehended,
by which it appeared that nothmg was discovered out a little
nist nxid fatty matter.
This having completed the evidence for the prosecution, Mr
Urquhart, advocate-depute, addressed the jury for the crown ;
after which Mr Crawford, in an ingenious speech, addressed
them for the accused, in which he twitted the public prosecutor
with discovering mysteries in the case as proved hj himself, and
most unwarrantably laying the burden of clearing up those
mysteries upon the prisoner, — a course he had no right to take.
The case, as now made out by him, turned out a very different
one from what it was put at hrst. In the previous evidence, he
had endeavoured to make out a case of kicking ; now he wished
to have all that evidence left out of view, and that they should
look entirely at the case as made out by the medical gentlemen,
who discarded the notion altogether of the woman having been
wounded by a kick. No mark of a kick could be traced, and
the medical gentlemen said if such a kick had been inflicted, it
would have been marked upon her person outwardly, and this
alone was suflicient to break up the prosecutor's case. Was
there any denial or concealment of the knife found on the
prisoner, or was there any the slightest evidence that he had
used that knife on that day or any other day, or of any ill-feel-
ing or malice entertained by him to his wife, except a petty
altercation at the beginning of the evening ? The presumption
from the previous frantic declaration of the deceased was rather
that she had inflicted the wound herself; at all events she never
300 TRIAL OF SAMUEL CLARK.
blamed the prisoner with cutting her, and did not seem to beliere
herself seriously injured. All the prisoner was said to hare
done was not proved to have been sufficient to kill his wife, and
what by competent evidence is declared to have killed her was
not proved to have been done by him.
The Lord Justice-Clerk, in a clear and able address of three
hours, commented upon the different parts of the evidence, and
explained to the jury, that if there was any mystery as to the
main fact of the case, viz. the guilt of the prisoner, of course it
was their duty to give the prisoner the benefit of that doubt, and
to acquit him. The charge as now put was not, it must be ad-
mitted, as at first stated, a charge of murder by kicks ; but still
the jury were bound to decide the case on the evidence, and the
connexion the prisoner was proved to have with the whole cir-
cumstances of the case.
The jury retired, and were absent about half an hour. On
their return, the chancellor intimated that they had by a large
majority found a verdict of " Not Proven."
With this verdict I perfectly agree. Considering the defec-
tive nature of the evidence, and the plausible defence of the
panel, they could not (giving the prisoner the benefit of any
doubt) properly arrive at anjjr other. But whilst I thus concur
with the deliverance of the jury, there are several points of
doubt which led them to this decision which require a few ob-
servations ; and to these it is my intention now briefly to advert.
1^^, Was this wound accidental? — This question, although
a very natural one, is scarcely deserving a moment's considera-
tion. The circumstance of Mrs Clark having never once alluded
to such an accident is of itself almost sufiicient to negative this
supposition. The possibility of such an occurrence was not,
however, entirely overlooked by the counsel both for the crown
and the prisoner; and one of the questions put to me was,
whether persons in a state of intoxication may not be seriously
injured without being conscious of their condition ? It must of
course be admitted that persons much intoxicated have sustained
serious injuries without being conscious of their nature or
severity. For example, the following case came under my own
observation two years ago : — A stout healthy man in a state of
intoxication, while dancing in a tavern near the canal-basin, tripped
himself and fell on the floor. When lifted to a seat, his foot was
observed to be turned to one side. One of his companions, sup-
posing it to be dislocated, gave it a pull and easily replaced it.
In less than an hour afterwards, he walked home without feeling
almost any uneasiness. When within a few yards of his lodgings,
he had to go off the |)avement to cross the street, and while doing
so found his foot again go out of its place. He was assisted home
by the police, and I was called upon to visit him, when I found
that the tibia was fractured about four inches above the ankle^
TRIAL OF SAMUEL CLARK. 301
with the fibula entire. The distance which he walked after the
bone was first reduced was nearly three quarters of a mile. — But
while many such instances might be adduced in illustration of
the fact that persons may be seriously injured while in a state of
intoxication without knowing it, it is equally true, on the other
hand, that persons in the same condition often imagine them-
selves seriously injured from the most trifling accidents ; so that,
were it contended that the wound in the vulva of Mrs Clark
was produced by accident, and she, being intoxicated at the time,
was unconscious of the mode in which it was inflicted, and of its
dangerous nature, one would be equally justified in supposing
that, had she really been injured in this way, she would inunedi-
ately have given the alarm, and made more noise about it than
the occasion required. The latter is the view I am inclined to
adopt ; for, while the former may be entertained in regard to
fractures, dislocation, and other injuries where the integuments
are entire, there can be no doubt that where blood appears alarm
is more easily excited. It is therefore very improbable that
this woman, when she saw her clothes streaming with blood,
and saw pools of it upon the floor, would not have directed the
attention of the inmates of the house to the real nature of the
injury, and pointed out the place, and the article which had pro-
duced it. The fact of her having sufficient sense left to induce
her to go to the kitchen for assistance, when she observed the
blood flowing, shows that she was not so drunk as to be unable
to give an account of the manner in which the accident had oc-
curred. But all chance of its being an accident is set aside by
the fact that there was nothing in the room that could produce
such an injury. The chamber-pots, the beds, the chairs, and, in
short, every article of furniture in the apartment, were examined
by the procurator-fiscal and myself, and nothing discovered
which could produce a wound of the same appearance.
2d, W<i8 the wound suicidal ? — This being a more probable
occurrence than the preceding, and as it was the opinion adopted
by the counsel for the prisoner at the trial, it is deserving of a
more careful consideration.
It has already been mentioned, that Professor Simpson stated,
in answer to a question put by the Court, " that it was very
improbable that the woman had inflicted the wound herself;" and
in answer to the same question I replied, ^' that I considered it
impossible, or at all events so difficult as almost to amount to an
impossibility," and to this opinion I still adhere. Its improba-
bility depends chiefly upon the place selected for the wound
bemg most unnatural. Universal experience is against the sup-
position that such a situation would be chosen for the purpose of
suicide. Wounds resulting from suicide inflicted by edged in-
struments are generally confined to the chest, throat, arm, or
abdomen. lu the latter they are rare. In all cases a blood-
302 TRIAL OF SAMUEL CLARK.
vessel or a vital organ appears to be aimed at. If Mrs Clark,
therefore, did commit smeide, she appears to have been the first
to strike a blow at hazard. Her anatomical knowledge could
not be such as to guide her with precision to the internal pudic
artery, the only blood-vessel of importance that could be readily
reached by the knife ; and if her intention was to injure the
uterus, she must be supposed to have had a more accurate know-
ledge of her parts than to direct the weapon against the pubes.
But, keeping m view the appearance and direction of the wound,
it is almost impossible that she could inflict it herself. It ran
downwards and inwards from left to right, and gradually became
deeper as it descended. Its appearance was such as to leave no
doubt on the minds of all who were present at the post mortem
examination, that the incision had commenced above and termi-
nated below the arch of the pubes somewhat abruptly. Now,
if correct in this supposition, she could only inflict it in one of
the two following ways, both of which are exceedingly difficult.
The labia must have been separated by the fingers of the left
hand, while the right, holding the knife, must either have passed
outside and underneath the right thigh, or come so closely
in contact with the left hand between the thighs as to have de-
prived her of the power of inflicting such a wound. The labia
in this woman were peculiarly large, and the part where the
wound was situated unusually deep. The nymphse were equally
prominent and overlapped each other, so as to shut up the en-
trance to the vagina ; so that their separation was indispensable
for accomplishing the object, whether the wound was inflicted by
the woman herself or by a second party, or some of the parts
must have been injured.
With a view of reconciling this situation of the wound with the
idea of its being the woman's act, it was attempted to be proved
that she was left handed, and one witness actually swore to this,
but it was not corroborated by the evidence of a second party.
Had it even been proved, it would not have removed the diffi-
culty which stood in the way of a satisfactory explanation ; for,
whilst it would explain why the wound was on the left side of
the orifice of the urethra, it left the fact of the wound having
commenced above and terminated below in the same obscurity
as before. The supposition that she committed the act in the
passage is equally untenable. The reason advanced in support
of this view was, that only one stream of blood was observed on
the floor of the passage, whereas, had she been cut before leaving
the room, there must have been two, the one produced in going
to the kitchen, and the other on returning. Had the blood been
flowing in a continuous stream, and not impeded in its course by
any part of her dress, there might have been some ground for
this opinion ; but when it is recollected that it was merely drop-
ping uregularly from her saturated clothes — ^that the passage
TRIAL OF SAMUEL CLARK. 303
was SO narrow that she could not deviate above a few inches on
her return from the track in which she went to the kitchen,
and that it was not observed at all till a considerable time had
elapsed, and after several persons had rendered it more indis-
tinct by trampling upon it, it is very unlikely that any one
could tell accurately whether there were one or two streams
observable on the floor of the passage. And is it probable that,
after inflicting upon herself a wound which she considered
mortal, she would immediately request the inmates of the house
to come to her assistance, and, with the view of immediately
passing into eternity, state in their presence that her husband
had '' Kicked her, and that she could not hve?" A most impor-
tant part of the evidence, which cannot be overlooked, was, that
after this she never left the room in which she expired, and con-
sequently had no opportunity of disposing of the knife or other
instrument with which she had inflicted the wound, and it must
have been discovered during the search that was made for it.
3d, Was Ifie wound inflicted by a second party ? — If it was
neither accidental nor suicidal, no alternative is left but to answer
this in the affirmative ; and the party most closely associated with
the act was the woman's own husband. The reasons in support
of such an opinion are,— /r^, Mrs Clark's dying declaration that
he was the cause of her death; second, the opportunity he
enjoyed of committing the deed; third, the circumstance of
his suddenly and unobservedly leaving the house the moment
she gave the alarm ; fourth, the falsehood of his declaration.
It is true that the dying woman never blamed her husband
with cutting or stabbing her, and this circumstance might in some
measure remove the idea of his being the guilty party. But
it is also true that no one is entitled to infer, from the vague
statement ''kicked in the belly," that she was kicked in the
private parts. Different statements appear to have been given
at different times, for two witnesses swore that she said that
" she was kicked in the lower part of the belly." The ill de-
fined manner in which she expressed herself as to the situation
and nature of the injury, coupled with the unvarying declara-
tion that '' she could not live," justifies the supposition that she
had a perfect knowledge of her condition, and only refrained
from disclosing it from a feeling of delicacy. She never once
hinted that she was going to have a miscarriage, an idea which
all in the house seemed to entertain and act upon; and even
had she been conscious of such an event, there was nothing in
it to cast such a gloom or presentiment of deaith over her mmd.
She had before hsA several abortions, and recovered perfectly in
them all. There was therefore nothing particular in this which
she had to dread ; and the only explanation which can be given
of her silence is, that the situation of the wound was such that
she could not mention it. Her dying declaration that her
304 TRIAL OF SAMUEL CLARK.
husband was the cause of her death, and an appeal she made to
himself on his return to the house, " Samuel, you've been a
kind man to me, but it's all over now," cannot be set aside as
referring to nothing, which thejr must do if her statement were
received Uterally, for not the shghtest trace of a kick could be
discovered.
If the witnesses had been more precise as to time, it would have
been more evident than was brought out on the trial, that the
period when Clark and his wife quarrelled, and he was seen by
his daughter to have kicked at her, and that when she called
for assistance, were quite distinct. Nearly half an hour had
elapsed, during which time they appeared in friendly conversa-
tion, and, as has been previously stated, were sitting on the foot
of opposite beds. The daughter at this time was out of the room,
and did not return till her father had gone out and the neigh-
bours had been called in to her mother's assistance; and on
coming in and finding all in a bustle, she inquired at her mother
what was the matter, when Mrs Clark replied, " Your father
has kicked me, and I can't Uve." Blood was then observed upon
the floor. The petty quarrel which the parties had on a previous
part of the evening had been forgotten — a very improbable
circumstance had blood continued to flow during the whole half
hour which had elapsed.
In reference to the remaining three circumstances alluded to
in support of Clark being the murderer of his wife, it is unne-
cessary to offer any observation by way of illustration. A wound
in a concealed part is always admitted as presumptive evidence of
murder. Now, if the situation of the two beds on which Clark
and his wife were sitting, their proximity to each other, and
the adaptation of his hand for infticting such a wound, be con-
sidered, no one had so good an opportunity as he had of perpe-
trating it. There was no one in the room who could do it
without Clark's connivance, for he was constantly beside her
till the moment she called for assistance ; and then how strongly
corroborative of his being the murderer is the fact of his in-
stantly disappearing from the house without attempting to
sympathize with her or offering to go in search of medical aid.
His object in going out, and the place he went to, were not dis-
covered. Every statement in his declaration in reference to
the quarrel and in explanation of the blood being about her
person was disproved, a circumstance also unfavourable to the
prisoner.
It is much to be regretted that an earlier inquiry was not
made into the circumstances of this case. One important point
in evidence might thus have been obtained. When Clark was
apprehended, blood was observed upon his hands and his clothes.
This however was at four o'clock in the morning, more than six
hours after the wound had been inflicted ; and it is possible that.
CASE OF EXTENSIVE CONGENITAL ULCERATION. 305
in lying upon the bed where his wife expired, he might acquire
these stains. But had he been taken into custody when he
was first seen by the poUce, shortly after he returned to the
house, and traces of blood then discovered, it would have been a
most material circumstance in the evidence.
Cdse of Extensive Congenital Ulce/i^ation of the Right Leg.
By T. BoswALL Watson, M.D., one of the Medical Officers
of the Leith Dispensary.
Mrs S., the mother of four children, one of whom only is alive^
was seized with labour pains of her fifth child at one a. m. of
18th January 1844 ; the breech presented, and the delivery was
somewhat tedious, not being completed until four p. m. the next
day. The child was well formed in every respect, and rather
above the usual size. The right leg presented the following
singular appearance : — On the forepart of the limb, and com-
mencing immediately below the knee, an ulcer, if it might be so
termed, extended in nearly a straight line to the ankle ; where,
crossing the instep, it extended downwards and inwards to the
sole of the foot, and forwards to within a short distance of the
great toe. The diseased part presented a brownish chocolate-
coloured appearance throughout its whole extent, and a serous-
looking fluid was secreted from its surface, which was not sensi-
bly raised above the level of the surrounding health;^ skin.
Towards the instep and plantar surface of the foot, the diseased
action seemed to be of a more severe character than on the
upper portion of the limb, the inferior part being considerably
darker in colour, and the secretion partaking more of the nature
of pus. A much greater extent of the limb had also evidently
been at one time mvolved in the disease, as distinct traces of
recent cicatrization presented themselves beyond the margin of
the part affected at birth. In the sole of the foot, as the process
■of healing had proceeded in utero, pretty strong bands had been
formed, so as to draw the foot somewhat inwards, constituting
thereby a very slight degree of varus. From the same cause,
also, the great toe was drawn inwards from the adjoining one.
The form of the part at birth, in a state of ulceration, bore a
marked resemblance to that of the tibia, having its greatest
width superiorly, corresponding with the situation of the head of
that bone, and narrowing gradually though irregularly as it
proceeded downwards. No vascular ramifications could be ob-
served, either in the preternatural formation itself, or in the
healthy skin surrounding it.
The infant evinced very considerable pain by screaming and
frequently drawing up the limb, but the general health did not,
2 Q
306 CASE OF EXTENSIVE CONGENITAL ULCERATION.
seem to be at all affected. The healing of the ulcer proceeded
gradually though slowly ; the brownish liver-coloured appear-
ance which the diseased part presented, changing first to a lakish
hue, and afterwards to a purple tint as it advanced towards com-
plete cicatrization, which in the sole of the foot was not accom-
Elished until about three weeks after birth. Some months,
owever, elapsed before the part assumed the colour of healthy
skin, though the form of the previously diseased portion can
still be easily recognised.
All marks of the texture of the skin are commonly classed
Under the convenient term of N(JBvi, but the above cannot be in-
cluded in the category, since it differs widely from the general
character of this order ; it may more properly be considered the
remains of a simple ulcer, over which, as regarded the singular
colour of the diseased part, the Uquor amnii might possibly have
exerted some influence. M. Rayer, in his work on Cutaneous
Diseases, mentions that the skin has been found primarily defec-
tive amongst new-bom infants ; but he does not state that any
case of the kind had ever come under his observation, or the
particular appearance which the integuments in such cases pre-
sented. He states having had an opportunity of examining an
example of extensive vascular nsBvus of the right fore-arm and
hand, not raised above the level of the surrounding skin, and of
a violet colour. Five weeks after birth it became affected with
inflammation in several places, which all gave way, and became
open ulcers. It differed, however, from the case above narrated
in not being in a state of ulceration at birth.
It might not be very profitable to speculate on the causes
which may give rise to such lesions ; but comparatively recent
pathologic inve3tigations, as will be found by consulting the
works of Billard, Rilliet, Barthez, and others, on the diseases of
children, have shown that the foetus in utero is much ofiener
affected with disease than was at one time supposed. In the
still-bom foetus, or in children who die soon after birth, signs of
pneumonia, pleuritis, peritonitis, gastritis, and enteritis, are not
unfrequently found on dissection. The cutaneous tissue, too, not
to mention syphilis, occasionally presents evidence of having
been the seat of disease, by the child at birth exhibiting exfolia-
tions of the skin, and iilcers, such as those already referred to,
involving the deeper-seated structures. Not a few instances are
related in the periodical literature of our profession, of the limbs
of the foetus having sloughed off in utero. Ghausaer and
Bedard, in the Diet des Sciences M^., t. xxxiv. p. 259, allude
to cases of this nature which they had seen ; and an example
somewhat similar was relate<]t by Ihr Potts of Jersey, in the fost
number of this Journal. In the third number of the Edin.
Journ^ of Med. Science for July 1826, is a remarkable instance
of congenital ulceration of the scalp, related by Dr WiUiam
PREGNANCY WITH OVARIAN ENLARGEMEJIT. 307
Campbell, lecturer on midwifery. The injured part presented
at birth, as in the infant born in my practice, a brownish appear-
ance. The ulcer was the size of a crown piece, became gan-
grenous, penetrated the longitudinal sinus, and on the eighteenth
day after birth destroyed the infant in a few minutes by hem-
orrhage amounting to about two pounds. This child was a
female, and had been born in December 1822 ; and the same
mother gave birth in March 1825 to a male child, who had also
on the scalp an ulcer resembling that on her previous child, but
it cicatrized; and the Uttle patient died soon afterwards of
chronic hydrocephalus.
Leith, 37, Constitution Street,
Augutt 5, 1844.
Pregnancy complicated with Ovarian Enlargement. By
Samuel Somerville, M. D., Edinburgh.
The following case of pregnancy occurring in a .woman with
considerable ovarian enlargement, may not be uniuteresting, and
shows how Uttle these tumours occasionally impede the progress
of labour, when, as in this instance, :the morbid growth is en-
tirely abdominal.
In the autumn of 1839, I saw for the first time Mrs M., then
labouring under peritonitis. She had previously consulted and
was at tne period alluded to under the care of my valued friend
Dr Thatcher, for an ovarian tumour .of the right side. The
pain in the abdomen was entirely confined to the locality in
which the enlargement was placed.
The disease had commenced about two years previously, and
had gradually increased to a great .size, when, from the patient
becoming alarmed, she consulted Dr Thatcher, who had ordered
for her cufferent preparations of iodine ; and it was for an inflam-
matory attack after the above date that 1 first saw her. By the
appUcation of leeches, the internal use of antimonials, and an an-
tiphlogistic regimen, the symptoms were subdued. I afterwards
continued to visit her, and to keep her under the same treatment ;
and during that time she had several attacks of peritoneal
excitement of more or less severity, but which always speedily
yielded to the usual treatment. In the early part of summer
1842, she began to complain of morning sickness, accompanied
by suppression of the catamenia, and other symptoms of preg-
nancy. I may mention, that though married for several years
she had no family. This want, however, was soon to be sup-
pUed. As the usual changes gradually developed themselves,
and as the term of pregnancy advanced, two distinct and sepa-
rate tumours could be felt — ^the one the uterus, occupying the
308 PREGNANCY WITH OVARIAN ENLARGEMENT.
left side of the abdomen, wlule the right wag filled with the
enlarged ovary. On the 12th January 1843, labour commenced :
on examination, the pelvis was found to be entirely free from any
part of the tumour : the labour pains continuing good, in a few
hours she was deUvered of a fine child, weighing to appearance
fully eight pounds. The latter sta^e of the function was more
I)rotracted m this case than it woum have been in an ordinary
abour, as the great abdominal enlargement prevented the nsasi
co-operation of the abdominal muscles with the uterus in expel-
ling the child. The placenta was thrown off naturally; the
woman had an excellent recovery, and nursed the cluld for
twelve months. The ovaiy has since shown no tendency to in-
crease. This patient, previously to impregnation, menstruated
regularly and healthily, showing, as has often been observed by
practitioners, that one ovary, when healthy, is sufficient to influ-
ence the uterus for the regular appearance of the catamenia, and
likewise for performing the function of reproduction. Some
years ago I had the privilege, through the kindness of Dr
Thatcher, of seemg another case of lal^ur, in which the ovary
occupied a great portion of the pelvis. Flactuation was dis-
tinctly felt, and Dr Thatcher resolved to tap the tumour from
the rectum ; this was accordingly done, and a considerable quan-
tity of glairy cerebriform matter escaped, which oonsiderably
reduced its size ; but the space being still inadequate to admit
the transit of the child, it became necessary to porform embry-
otomv. The patient recovered from the effects of the laboar;
but the artificial opening into the rectum continued pervious, and
through it, at different times, a discharge of the same aspect as
at first afterwards appeared.
This patient died some time subsequently; and on examinatiaii,
the enlarged ovary was found to contain a considerable quantity
of hair, said also a tooth. It was much inferior in size, however,
to the ovary in the former case, but from its positicHi it proved
a much more troublesome obstruction to the transit of the foeftos.
Case af Omffeniial SmhiliSy with Oburuations. By Wnxuii
Strange, M. D., of Ashton-under-Lyne.
Perhaps the following case of congenite syphilis, atthoagh it
may not decide, may be thought not malapropos to tlie aminJile
dispute between Dr W. Campbdl and Mr Acton, with wludi the
readers of the first two numbers of this Joomal are acquainted.*
Mrs F y a healthy and plethoric woman of about thirtj^
years of age, ap]£ed to me on the 13th March 1841, uder die
• See Nnnbm L aDdllL fiv M^ wd JoK.
CASK OF CONGENITAL STPHIUS. 809
following circumstances : — She was about eight months advanced
in pregnancy of her third child ; both of the two former births
were premature, one child having been born dead and putrid,
the other surviving its birth by only a few hours. On the
present occasion she applied to me in order that, if possible, a
similar fate might be averted from her present burden. In each
of her pregnancies she had enjoyed uninterrupted good health,
and had been entirely free from any of those distressing symp-
toms which often affect women in her state. In fact, she said
that '' it was her opinion that she was too well to be having
children." On the supposition that plethora might be the pro-
dii^sing cause of premature labour in these cases, I bled
her pretty freely ; notwithstanding, she was delivered of a dead
child on the 17th, four days after. The child was well formed
and quite free from any syphilitic appearances ; it seemed to
have been dead about a day or two. 1 told her to apply to me
much earlier in her. next pregnancy, which she did. May 4,
1842, I again bled her, she being three months gone of her
fourth pregnancy, and still healthy and plethoric ; near the end
of the fifth month I again bled her, ana again in the middle of
the seventh month. At the full time she was delivered of a liv-
ing child, apparently healthy, but not plump. Six weeks after,
the child exhibited indisputable evidence of a syphilitic taint.
There were large copper-coloured scaly blotches on the nates,
thighs, and genitals, which afterwards spread all over the trunk,
arms, and face ; the mucous membrane of the nose was inflamed,
and discharged an ichorous mucous fluid ; suffocation was often
threatened from the tumefied state of the inner side of the aim
and septum nasi.
The child took the p. hydrarg. ip. creta for about two months,
with an interval, and ultimately recovered, and is now well. To
the mother, about eighteen pills of blue mass with aloes were given
as an alterative. January 4, 1844, 1 delivered this woman of her
fifth child, no previous bleeding or treatment having been bad
recourse to. It was very healthy, plump, and free from any
appearance of syphilitic taint whatever, m which state it now
remains. The mother, a very respectable woman, has never
had either primary (to her knowledge), and certamly not second-
ary symptoms in her life. The husband has frequently bad
gonorrhcea, and had syphilis previous to the birth of her third
child, but how long before could not be r^nembered* He how-
ever was, as he thought, very careful in not eommnnicating the
disease to his wife, and believed himself cured of it
Now, in what manner does this somewhat interesting ease
bear npon the dispute in question? Is it ccmtended that a
male parent who has at $ome time or other had syphilis, bot
believes himself cored of it, is capable of commonicatiog a
syplutitic taint to the Mood or to tae constitution of a feinile
310 CASE OF CONGENITAL SYPHILIS.
parent, in consequence of which the offspring shall be born with
indisputable marks of the disease, the mother all the while never
exhibiting the slightest trace of it ? Of this position the pre-
ceding case, if not a proof, is at least a great support. The
question arises, however, were the three first births premature,
owing to the action of the syphilitic taint of the mother npon
the child, upon the \iteru8, upon both, or upon neither ? If we
suppose that syphilis, by causing death and putridity of the
foetus only, disposes the uterus to expel its contents, we are
perplexed by one child having been born alive, though prema-
ture, previously to any of the bleedings or other treatment having
been practised. If the action be exerted upon the uterus only,
can we suppose that the three bleedings during the fourth
pregnancy aestroyed this action upon the uterus, and thus
enabled the woman to go to the full period? How account,
upon that supposition, for the excessive degree of syphilitic
disease which affected the child in six weeks afterwaros ? If
neither the uterus nor the foetus be interfered with by the
presence of a syphihtic taint in the mother, as Mr Acton and
others seem to affirm (at least to the extent of causing abortion),
then how shall we account for the host of cases arising in
private practice, in which abortion with a dead or syphilitic child,
and the fact of one parent havbg had syphilis prior to or during
the gestation of that foetus, are constantly concurrent ? Ldstly,
if we suppose that both the functions of the uterus and the life
of the foetus are either conjointly or separately interfered with
by the existence of a syphihtic taint existing in the blood of the
mother dm-ing gestation, then we may easily and logically ac-
count for all the facts of the preceding and other similar cases.
let. It cannot be contrary to our established principles of phy-
siology to believe that a male parent, who has had syphilis at
some former period, and whose constitution, although no primary
symptoms any longer exist, is not cleared of the effects of the
poison, may communicate to the female parent a syphilitic taint,
that is, a morbid condition of constitution similar to that under
which he himself labours ; which communication is effected by
the absorption of the seminal fluid, in which the morbific power
exists, by the mother's system, and the subsequent corruption of
her own constitution, without of necessity any primary or
secondary symptoms having been induced in her.
2dly, If the first proposition be allowed, we know that a
contagious disease, as small-pox, may be imbibed by the
mother, and, without producing any appearances of it in her,
may fix itself entirely upon the chila, denoted by the existence
of the pustules at bu'th. Consequently, the deposition of the
whole of the virus upon the system of the child may be
equally effected in the case of syphilis. 3^/y, The more or
less early period of gestation at which this morbific power ia
CASE OF CONGENITAL SYPHILIS. 311
communicated to the foetus, or perhaps the more or less early
period at which the continued deposition of such power shall have
arrived at a certain height, will determine the period at which
abortion may take place ; either in consequence of the morbid
action of the uterus, or of the disease or death of the foetus.
And, 4:tMy, It is quite possible that this morbific influence may
be expended successively upon several foetuses, or that the
whole of it may be exhausted upon one, in such manner, that
the mother's system being now freed from it, without medical
treatment, a healthy and Hving child may at length be pro-
duced.
In concluding these observations, I wish to bear testimony
to the industry and zeal with which Mr Acton pursued his
observations in the Venereal Hospital of Paris under M.
Ricord and his colleague, during my own studies there ; at the
same time I am convinced that some years of extended private
midwifery practice will induce him to change his present
opinions. The cases of prostitutes cannot, I imagine, satis-
factorily settle this question, because abortion in them is so
common a thing, and is so often brought about by the action of
other causes than the existence of a syphihtic taint in their
constitution. Neither can he rely upon their evidence as to
when they had the disease, or if they had it at all, and whether
cured or not. That Dr Campbell's views are just I will not
arrogantly assert ; but I am as convinced of it as it is possible
for one to be upon a question which admits of so much argument
on both sides.
Part IL— REVIEWS.
A Bill for the better Regulation of Medical Practice throughout the United
Kingdom, (Prepared and brought in by Sir James Graham and Mr
Manners Sutton.) Ordered by the House of Commons to be printed,
7th August 1844.
"We sacrifice several reviews prepared for this number for the purpose of
laying before our readers an exact transcript of the new Medical Reform
Bill, as read a first time on the 7th of August in the House of Commons,
and ordered to be printed. To the loud and long outcry for medical reform,
not always we suspect with the self-same objects on the part of all who
joined in it, a response is at last made by the introduction of a bill into
Parliament by a minister of the crown. This bill, brought in by the
Home Secretary and Mr Manners Sutton, appears to have swallowed up,
with the consent of the authors, the two embryo bills which preceded it.
Mr Warburton and Mr Hawes, the respective authors of the former bills,
neither of which long suryived the stage of printing, both expressed in the
debate their satisfaction with the general features of the new bill ; and Mr
Macaulay seconded the motion for the first reading.
312 MEDICAL REFORM BILL.
It is Voltaire who says, when a Frenchman and an Englishman agree
they are sore to he in the right. Here we have Conservative, Whig, and
Whig-Radical memhers — ^unwonted sight !— concurring in praise of a mea^
sure. We, however, are of a cautious temper, and like to judge for our-
selves after sleeping and waking on such a suhject. The new measure pro>
poses less of a radical reform than either of the two former, which did indeed
smack a little of annual parliaments and universal suffrage. The Home
Secretary's hill rejects the idea which, under all kinds of circumstances, has
so often proved abortive in our times, that of expecting the immediate
correction of evils by a constitution framed on paper, however well consid-
ered, and, borrowing from the dear-bought experience of the political world,
it seeks to rear up a new order of things in the province of medicine merely
by retrenching some parts of the old system, and infusing a fresh spirit into
such parts of it as are to be retained. Without further comment we leave
. the bill in the hands of our readers.
[Note. — The Words printed in Italics are proposed to be inserted in the Committee.]
Whebeas it is for the good of all her Majesty's subjects that the know-
ledge of physic and surgery should be promoted, and that means should be
afforded whereby those who have been examined and found skilful by com-
petent authority may be known from ignorant and unskilful pretenders to
the same knowledge : And whereas the laws now in force concerning the
profession of physic and surgery require to be amended, Be it enacted by
the Queen's most excellent Majesty, by and with the advice and consent of
the Lords Spiritual and Temporal, and Commons, in this present Parliament
assembled, and by the authority of the same, that an act passed in the third
year of the reign of King Henry the Eighth, intituled, " An Act for the
appointing of Physicians and Surgeons ;"^ and also another act passed in the
fifth year of the same reign, intituled, " An Act concerning Surgeons to be
dischai^ed of Quests and other Things ;"^ and also another act passed in the
session of Parliament holden in the fourteenth and fifteenth yeai*s of tlie
same reign, intituled, " The Privileges and Authority of Physicians in
London ;"^ and also two acts passed in the thirty-second year of the same
reign, respectively intituled, *' For Physicians and their Privilege,"* and
" For Barbers and Surgeons ;"* and also another act passed in the session of
Parliament holden in the thirty-third and thirty-fourth years of the same
reign, intituled, *'A Bill that Persons being no common Surgeons may
minister Medicines, notwithstanding the Statute ;"^ and another act passed
in the first year of the reign of Queen Mary, intituled, " An Act touching
the Corporation of Physicians in London ;"7 and also an act passed in the
session of Parliament holden in the sixth and seventh years of the reign of
King William the Third, intituled, " An Act for exemptiug Apothecaries
from serving the Offices of Constable, Scavenger, aod other Parish and
Ward Offices, and from serving on Juries ;"® and so much of every other
act as continues the last-recited act ; and also an act passed in the tenth
year of the reign of King George the First, intituled, " An Act for the better
viewing, searching, and examining of all Drugs, Medicines, Waters, Oils,
Compositions, used or to be used for Medicines, in all places where the same
shall be exposed for Sale, or kept for that purpose, within the city of Lon-
» 3 Hen. VIIL c. 11.— » 5 Hen. VIIL c. 6.—^ 14 & 15 Hen. VI fL c 5.—
* 32 Hen. VIH. c. 40.—* 32 Hen. VIII. c 42.— « 34 & 36 Hen. VIIL c 8.—
7 1 Mary, Sess. il. c 9.— « 6 & 7 Will. III. c 4.
MEDICAL REFORM BILL. 313
don and Suburbs thereof, or within Seven Miles circuit of the said City "^
and 80 much of another act passed in the eighteenth year of the reign of
King George the Second, intituled, '^ An Act for making .the Suigeons of
London and the Barbers of London two separate and distinct Corporations,"^
as does not relate to the separation of the said corporations, or to the master,
governors, and commonalty of the Mysteiy of Bcurbers in London ; and also
so much of an act passed in the fifty-fifth year of the reign of King Greorge
the Third, intituled, *^ An Act for better r^ulating the Practice of Apothe*
caries throughout England and Wales,"^ as relates to the examination of
apothecaries, or to the qualifications of persons intending to be examined or
to qualify themselves under that act to practise as an apothecary, or to the
fees to be paid by apothecaries for the certificate of the court of examiners,
or to the penalties for pi'actising as an apothecary without having obtained
such certificate ; and also so much of an act passed in the sixth year of the
reign of Kmg Greorge the Fourth,^ as enacts, that all members and licentiates
of the Royal College of Physicians in London actually practising ; ail sur-
geons being members of the Royal Colleges of Surgeons in London, Edin-
burgli, or Dublin, and actually practising ; all apothecaries certified by the
court of examiners of the Apothecaries' Company, and actually practising,
shall be freed and exempt from being retunied, and from serving upon any
juries or inquests whatsoever, and shall not be inserted in the lists to be
prepared by virtue of tliat act ; and also so much of any act or charter
granted before the passing of this Act as prohibits any person from practis-
ing physic or surgery in any place without such license as is mentioned in
such act or charter respectively, or as imposes any restriction on the practice
of physic or surgery other than is contained in this act, sliall be repealed
and annulled.
And be it enacted, that a council shall be established, which shall be styled
" The Council of Health and Medical Education ;" and that one of her
Majesty's principal secretaries of state shall be a member of the said council,
in right of his office as secretary of state ; and that the regius professor of
medicine in the University of Oxford, the regius professor of physic in the
University of Cambridge, the regius professor of physic in the University of
Dublin, the regius professor of clinical surgery in the University of Edin-
burgh, and the regius professor of surgery in the University of Glasgow,
shall be members of the said council in right of their several professorships ;
and that the other members of the said council shall be one physician and
one sui^geon, to be chosen by the Colleges of Physicians and Surgeons of
England respectively ; one physician and one surgeon to be chosen by the
Colleges of Physicians and Suigeons of Scotland respectively ; one physician
and one surgeon to be chosen by the Colleges of Physicians and Sui^geons
of Ireland respectively ; and six other persons whom her Majesty, with
the advice of her privy council, shall deem fit to be members of the said
council.
Provided always, and be it enacted, tliat it shall be lawful for her Ma-
jesty, with the advice of her privy council, to appoint all the members of
the fiirst Council of Health and Medical Education, other than those who will
be members thereof in right of their several offices ; and that at the end of
the third and each of the ttoo next following years after the first constitu-
tion of the said council, one physician and one surgeon of those first
' 10 Geo. L c. 20.—" 18 Geo. IL c. 15.— » 56 Geo. III. c. 194. ~*6 Geo. IV.
c. 50, 8. 2.
2 R
314 MEDICAL REFORM BILL.
appointed on behalf of the said several colleges of physicians and sargeons,
shall go out of office, in such order as her Majesty, with the advice of her
privy council, shall direct.
And be it enacted, that those members of the said council who are mem-
bers in right of their several offices shall continue to be members thereof so
long as they hold the same offices respectively, and no longer, and the siv
members of the said council, appointed as aforesaid by her Majesty with the
advice of her privy council, shall continue to be members of the said
council during her Majesty's pleasure, and upon every vacancy among the
last-mentioned members of the said council, and their successors, it shall be
lawful for her Majesty, with the advice of her privy council, to appoint
another fit person to be a member of the said council during her Majesty's
pleasure.
And be it enacted, that upon every vacancy among the members of the
said council appointed on behalf of the said several colleges of physicians or
surgeons, and their successors, the Royal College of Physicians or Surgeons
of England, Scotland, or Ireland, as the case may be, shall appoint another
physician or sui*geon, as the case may be, to supply such vacancy, subject
to the approval of her Majesty ; and every member of the council so chosen
shall be entitled to be a member of the said council for three years, and
shall then go out of office, but may forthwith be re-chosen, subject to
her Majesty's approval :* provided always, that no president, vice-president,
or examiner of any of the said colleges shall be quidified to be so appointed.
And be it enacted, that the manner of choosing the last-mentioned mem-
bers of the said council shall be determined in each case by orders or bye-
laws to be made from time to time by the said several colleges, subject to
the approval of the Council of Health and Medical Education.
Provided always, and be it enacted, that it shall be lawful for any mem-
ber of the said council appointed by her Majesty, or chosen by any of the
said colleges, at ahy time to resign his office, or for her Majesty at any time,
with the advice of hie^ pilvy council, to dismiss any such member of the
said council for notorious misbehaviour or unfitness ; and upon any vacancy
in the said council by death, resignation, or dismissal, another member of
the council shall be appointed in the same manner and for the same term
as the member by whbm the vacancy shall have been made.
And be it enacted, that it shall be lawful for the said council, with the
approval of one of her Majesty's principal secretaries of state, to appoint a
principal secretary for the said council, and also local secretaries for Scot-
land and Ireland, and so many clerks and messengers, as the said secretary
of state shall deem necessary, and also with the like approval to remove at
their pleasure any of the said secretaries, clerks, and messengers, and
appoint others in their room.
And be it enacted, that there shall be paid to the members of the said
council, and to the said secretaries, clerks, and messengers, such salaries as
shall be from time to time allowed by the lord high treasurer or commis-
sioners of her Majesty's treasury, who may also allow such reasonable
travelling expenses which may have been incurred by any member of the
said council, or any secretary, clerk, or messenger in the performcmce of his
duties under this act, and such other reasonable expenses of putting this
act into execution, as the said lord high treasurer or commissioners of her
Majesty's treasury shall think fit.
And be it enacted, that the said secretary of state shall be president of
the said council, and shall be empowered from time to time to nominate
MEDICAL REFORM BILL. 315
one of the members of the council appointed as aforesaid by her Majesty
to be yice-pi'esident of the council, and to act as president in his absence ;
and at every meeting of the council, in the absence of the president and
vice-president, some other member to be chosen by the council from the
members then present shall be empowered to act as president.
And be it enacted, that the said council shall be holden in such places
and at such times as the secretary of state ^m time to time shall appoint ;
and that all acts of the council shall be decided by the votes of the
majority of the members present at any meeting, the whole number not
being less than sewn ; and at all such meetings the president for the time
being shall have a second or casting vote in all cases of equality of votes.
And be it enacted, that minutes of the proceedings at all meetings of the
council shall be drawn up and fairly entered in books, to be kept for
that purpose ; and such minutes shall be at all reasonable times open to
the inspection of any person or committee appointed for the purpose of in-
specting them by any of the said universities or colleges.
And be it enacted, that a register shall be kept and published from time
to time, under the direction of the said council, of all persons who shall
have been examined, and shall have received, and shall exhibit before the
said council letters testimonial, as hereinafter mentioned, of their qualifica-
tion to practise as a physician, or as a surgeon, or as a licentiate in medicine
and surgery ; for which registry the council shall be entitled to have from
the person requiring to be registered a fee oi five pounds in the case of a
physician or surgeon, and a fee of two pounds in the case of a licentiate,
which fees shall be applied towai-d defraying the expenses of this act ; and
every person whose name shall be so registered, who shall be desirous that
his name shall be continued in the published register, shall in the month
of January in every year send to the said council his name and place of
abode, with the date of his testimonials, and the council shall verify the
returns so made to them by comparison with the register kept by them,
and shall forthwith cause the names of all persons duly registered, and so
returned to them, to be published in alphabetical order in their several
classes, with their several places of abode, and dates of their testimonials.
And be it enacted, that no person, except such graduates in medicine
and such other legal practitioners as are hereinafter mentioned, shall be en-
titled to be registered by the council as a licentiate in medicine and surgery
unless he shall have attained the age of twenty-one years, and shall have
been examined by the colleges hei-einafter named.; (that is. to say) if in
England, examined by the Royal College of Physicians of England, assisted
by the Court of Examiners of the Apothecaries' Company, and also ex-
amined by the Royal College of Surgeons of England ; and if in Scotland,
examined by the Royal Colleges of Physicians and Surgeons of Scotland ;
and if in Ireland, examined by the Royal Colleges of Physicians and
Surgeons in Ireland ; and in every case shall have received letters testi-
monial from each of the bodies by which he shall have been examined, of
his being duly qualified to practise as such licentiate. •
And be it enacted, that no person, except such legal practitioners as are
hereinafter mentioned, shall be entitled to be registered by the council as a
surgeon unless he shall have attained the age of twenty five years, and shall
have been examined by one of the Royal Colleges of Surgeons of England,
Scotland, or Ireland, or the Royal College of Physicians and Surgeons of
Glasgow, after such proof as shall be satisfactory to the examinmg college
that he has applied himself to surgical studies during at least five years ;
316 MEDICAL REFORM BILL.
and shall have received letters testimonial from the examining college of
his being duly qualified to practise as a surgeon.
And be it enacted, that no person, except such legal practitioners as are
hereafter mentioned, shall be entitled to be registered by the council as a
physician unless he shall have attained the age of twenty-six yean, and
shall have graduated in medicine in some university of the United Kingdom
of Great Britain and Ireland, or, subject to the restriction hereinafter con-
tained, in some foreign university, and shall also have been examined by
one of the Royal Colleges of Physicians of England, Scotland, or Ireland,
or by the Royal College of Physicians and Surgeons of Glasgow, after such
proof as shall be satisfactory to the examining college that he has applied
himself to medical studies during at least five years, or if he is not a
graduate in medicine of any such university, unless he shall have attained
the age oi forty years, and shall have been examined by the Royal College
of Physicians of England ; and in each case shall have received letters
testimonial from the examining college of his being duly qualified to
practise as a physician ; and no person shall be entitled to be received for
examination for the purpose of being so registered as a physician upon a
foreign degree in medicine, unless the Royal College of Physicians of Eng-
land, Scotland, or Ireland^ shall give him a special certificate, to be laid
before and approved by the Council of Health and Medical Education, that
they have made inquiry into the manner in which such degree was con-
ferred, and have ascertained (that it has been granted after residence within
the precincts of the same university during at least one year^ and after due
examination and upon satisfactory certificates of previous study.
And be it enacted, that it shall be lawful for the same person, if possessed
of the necessary testimonials, to be registered as both physician and surgeon,
and for a registered physician, or a person applying to be registered as 8
physician, to ofier himself for examination as a licentiate in surgery by one
of the said Royal Colleges of Surgeons, and for a registered surgeon, or ft
person applying to be registered as a surgeon^ to offer himself for examina-
tion as a licentiate in medicine by one of the said Royal Colleges of Physi-
oians, assisted in England by the Court of Examiners of the Apothecaries'
Company ; and every such physician or surgeon shall be entitled to be also
registered upon the testimonials granted to him upon such additional
examination, in such form and manner as shall be determined by the said
council.
And be it enacted, that every person registered acfter examination as a
physician or surgeon under this act, shall be admitted as an associate of
the Royal College of Physicians, or as fellow of the Royal College of Surgeons
from which he shall have received his letters testimonials as physician or
surgeon, or if he shall have received the said testimonials from the Royal
College of Physicians and Surgeons of Glasgow, then as a fellow of the last-
mentioned royal college ; and every such physician and ^surgeon who shall
afterwards remove from that part of the United Kingdom in which he
obtained his letters testimonial, shall be required, if he shall practise as a
physician or surgeon in any other part of the said United Kingdom, to
enroll himself as an associate of the Royal College of Physicians, or as a
fellow of the Royal College of Surgeons, of that part of the United Kingdom
to which he shall so remove, for the purpose of practising there^ according
to the nature of his testimonials, and in each case shall be entitled to be so
admitted without further examination, and on payment of the like fees of
admission, and on complying with the same conditions as are required of
MEDICAL REFORM BILL. 317
other persons who have passed iheir examinations for the purpose of hcing
admitted associates or fellows of the said colleges respectively.
And be it enacted, that the said several colleges shall, from time to time,
when required by the said council, prepare and lay before the said council
a scheme or schemes of the course of study and particulars of the ex-
amination to be gone through by all persons applying to such colleges re-
spectively for letters testimonial as physician, or surgeon, or licentiate, and
of the fees to be taken for examination and admission into the said several
colleges respectively ; and the said council shall be empowered to make
from time to time such changes in any of the schemes so laid before them
89 to the said council shall seem expedient ; and the said council shall
endeavour to procure, as far as is practicable and convenient, that the
qualifications and fees for the said testimonials shall be uniform, according
to the nature thereof throughout the said United Kingdom.
And be it enacted, that after the pasting of this act it shall not be
lawful for any university of the said United Kingdom to confer any
d^^ree in the &culty of medicine upon any person, unless he shall have
been matriculated in the same university, and shall have duly attended
the courses of public lectures prescribed by the same university to
students in medicine within the precincts of the same university, or of
some medical school recognised by and in connexion with the same
university^ during at least tu>o years next before the granting of such
degree, and shall have been examined at some time before granting such
degree by the proper examiners of such university, and found by them
to possess competent skill and knowledge of medicine, and of the sciences
connected therewith, and of the English and JU^tin languages at least ;
and every diploma or ceilificate of a medical degree granted by any such
university after the pasting of this act^ shall set forth distinctly the time
which has elapsed since the matriculation of the person to whom such
degree shall be granted, and the time during which^ and place at which he
shall have actually studied as aforesaid, and the fact that he has passed
such examination as last aforesaid.
And be it declared and enacted, that it shall be Jawf ul for any university
of the said United Kingdom to grant the degree of bachelor in the &culty
of medicine, subject to the restrictions hereinbefore contained concerning
medical degrees, to any stude^it of the same university who shall have
attained the age of twenty-two years % and that every such graduate in the
faculty of medicine, being ^so examined and having received letters
testimonial of his qualification in the manner hereinbefore prescribed in
the case of licentiates in medicine and surgery, or examined and furnished
with the like letters testimonial by the Royal College of Physicians and
Suigeons of Glasgow, if the said degree shall have been granted by the
University of Glasgow, shall be entitled to be registered by the said
Council of Health and Medical Education as a licentiate in medicine and
surgery, subject to such general regulations as shall be made by the said
council concerning the registry of licentiates.
And be it enacted, jthat no bye-law to be made by any of the Royal
Colleges of Physicians or Suigeons of England, Scotland, or Ireland re-
spectively, or by the Royal College of Physicians and Surgeons of Glasgow,
shall be of any force until a copy thereof, sealed with the seal of the same
college, shall have been laid before and approved by the said Council of
Health and Medical Education.
And be it enacted, that it shall be lawful for the said council to make.
318 MEDICAL REFORM BILL.
regulations for ensuring the registry of all medical and surgical students
by the proper ofi&cers of the several hospitals or medical or suigical schools
at which they shall study, and to authorize such officers to take a fee for
such registration, not being more in each case than ten shiUingSy and for re-
quiring all such fees to be remitted to the secretary of the said council,
and returns to be made to them of the registration of all such students, in
such numner and form as the council shall think fit ; and no hospital or
medical or surgical school shall be recognised by any of the said colleges,
which shall neglect or refuse to give due effect to such regulations, after
notice of such neglect or refusal shall have been sent by the said council
to the said colleges, until the default of such hospitsd or medical or
surgical school be amended to the satisfaction of the said council, and aU
such fees shall be applied toward the expenses of this act.
And be it enacted, that where by this act it is provided that the concur-
rence of more than one body is required for qualifying any person to be
registered by the said council, the examination befbi% such bodies for his
degree or letters testimonial, or both, may be conducted either separately
before examiners appointed by each body, or before a joint board of exam-
iners, to be appointed by each body separately or conjointly, who shall be
appointed in such number, manner, and form, and shall hold their examina-
tions at such times and places as such bodies shall, with the approval of the
said council, agree from time to time among themselves, or as shall be
detennined by the said council with respect to any point in which they
shall not be agreed ; and where there shall be separate examinations before
examiners appointed by each body, the subjects and fees of examination
shall be divided among such bodies as they sliall from time to time agree
among themselves, or as the said council from time to time shall determine
with respect to any subject on which they shall not be agreed.
And be it enacted, that the said council may from time to time require
returns to be made in such form, and including such particulars, as they
shall think fit, respecting the examinations to be conducted as aforesaid, and
it shall be lawful for any secretary of the said council, deputed by the
council for that purpose, or for any member of the said council, to be pre-
sent at any of the said examinations ; and if the council shall be of opinion
that the regulations prescribed by them for the examination and grant of
letters testimonial as physician, surgeon, or licentiate, have been infi-inged,
evaded, or neglected by any of the said examining bodies, it shall be lawful
for the said council to refuse to register upon the testimonials of the body
so in default, until the same be amended to the satisfaction of the said
council.
And be it enacted, that, subject to the reservations hereinafter contained,
no person, after the passing of this acty who is not registered by the said
council, shall be appointed to any medical or surgical office in any public
hospital, prison, infirmary, dispensary, workhouse, or other public institu-
tion in the said United Kingdom, or to any medical or suigical office in
her Majesty's army or navy, or in the service of the Honourable East
India Company, except in India, natives of India duly qualified according
to such laws or regulations as are or shall be made in that behalf by the
governor-general in council-; and wherever by law it is provided that any
act shall be done by a physician or surgeon, or medical or surgical practi-
tioner, by whatever name or title he is called, such provision shall be con-
strued, after the passing of this acty to mean a person qualified to be
appointed to such medical or surgical offices as aforesaid ; and the Council of
MEDICAL REFORM BILL. 319
Health shall be empowered from time to time to make regulations for
specifying what institutions are to be considered public institutions within
the meaning of this act, and which form of testimonial shall be necessary
to qualify the holder thereof for every such situation.
And be it enacted, that all persons who are registered by the said council
as physicians, surgeons, or licentiates, shall be exempt while practising as
such from being summoned or serving on all juries and inquests whatsoever,
and from serving all corporate, parochial, ward, hundred and township
offices ; but, subject to the reservations hereinafter contained, no person
shall be entitled to such exemption, on the ground of his practising medi-
cine or suigery, who is not so registered, nor shall the certificate of any
such unregistered person, given after the passing of this act, be received as
the certificate of a medical or surgical practitioner in any court of law, or in
any case in which by law the certificate of a medical or surgical practitioner
is required.
Provided always, and be it enacted, that it shall be lawful for the jsaid
council, on the application, within ttoeive calendar months after the passing
of this acty of any person legally practising as a physician^ surgeon, or
apothecary, at the time of the passing of this act, in any part of the United
Kingdom of Great Britain and Ireland, or on the application within two
years of any person so legally practising in any of her Majesty's colonies
and foreign possessions, to cause the name of such person to be registered as
a physician, surgeon, or licentiate in medicine and surgery, as the case may
be, on production to the said council of his diploma, license, or certificate,
or such other proof as shall be satisfactory to the said council, that at the
time of the passing of this act he was legally entitled to practise as a physi-
cian, surgeon, or apothecary, as the case may be^ in some part of the said
United Kingdom, and on payment of a ffe'e of two pounds in the case of
fellows or associates of the said colleges of physicians and surgeons respec-
tively, and oi five shillings in every other case^ which fees shall be applied
towards the expenses of this act ; and during the said period of twelve
calendar months every person legally practising as a physician, surgeon, or
apothecary at the time of the passing of this act in the said United Kingdom,
and during the said period of two years, every person s6* legally practising in
any of her Majesty's colonies and foreign possessions, although not registered,
shall continue to enjoy the same privileges and exemptions, and be qualified
to be appointed to the same offices, and to practise in the same manner as if
this act had not been passed, and no farther or otherwise, unless registered
under this act.
And be it enacted, that every person appointed after the passing of this
act to any medical or surgical office for which he is not qualified according
to the provisions of this act, and the regulations of the said council, and who
shall act or practise in such office, shall for every such offence forfeit the
sum of twenty pounds, to be recovered by action of debt, or information to
be brought in any of her Majesty's Courts of Record at Westminster, or in
the Court of Exchequer in Scotland, or in Dublin, within six calendar
months next after the commission of the offence, and to be recovered in the
name of her Majesty's attorney-general in England or Ireland, or of the
lord advocate in Scotland.
And be it enacted, that after the passing of this act^ no person shall be
entitled to recover any charge in any court of law for any medical or
surgical advice, attendance, or operation, or for any medicine prescribed or
administered^ unless he shall prove upon the trial, either that he is regis-
320 DROPSICAL OVARIA.
•tered under this act, or that he was legally practisiDg in the capacity in
which he claims such charge hefore the passing of this act.
And be it enacted, that every unregistered person who shall wilfully and
fisJsely pretend to be, or take or use any name or title implying that he is
registered under this act, shall be deemed guilty of a misdemeanour in Eng-
land and Ireland, and in Scotland of a crime and offence, and being con-
victed thereof, shall be punished by fine or imprisonment, or both, as the
court before which he shall be convicted shall award.
And be it enacted, that this act may be amended or repealed by any act
to be passed in this session of Parliament.
Cotes of Dropsical Ovaria rerhoeed by the Large Abdominal Section. By
D. Henry Walne, Esq., Sui^on. London, 1843. 8vo. Pp. 66.
Weui do we remember the excitement produced among the more influen-
tial part of our brethren and their retainers, when the removal of ovarian
tumours was first practised in this city ; and equally well do we recollect
the obloquy with which the operator and his assistants were assailed. But
notwithstanding the very unfavourable reception which the operation in
question experienced in those times, we always maintained, and our opi-
nions have been most satisfactorily corroborated by Mr Walne and others,
that under particular circumstances the removal of ovarian tumours by an
extensive section of the abdominal parietes was as justifiable, and M'ould
prove as salutary in its results^ as many other surgical operations of a far
less formidable character. We are informed, for example, that Dr M^Dowal
of the United States laid open the abdominal cavity six times, and that five
of his patients recovered. We know that of six women operated on by Mr
Lizars of this city, three recovered ; seven out of fourteen operations by
Dr Clay of Manchester succeeded ; and, besides the three cases detailed in
the work under review, it would appear that Mr Walne operated on two
other individuals, and that of the whole four recovered. We are aware of
sixty-eight operations of this nature, including two cases by Mr Lizars
which had not been published ; and of the whole it would seem that forty-
two recovered, being nearly two-thirds of the number operated on.* It
would be rather wandering from the design of our present observations,
otherwise it could be easily shown from the practice of such of our brethren
as devote their time in a more especial manner to the operative department
of the profession, that the success of the present operation has fully equalled
that of cases of a far less formidable nature.
Mr Walne has proved himself a bold surgeon ; and the fact of so many of
his patients having recovered, equally entitles him to be considered a judi-
cious practitioner. But we must not overlook that he had the counsel and
assistance of Dr Blundell, one of the most talented men of the age ; and that
his patients, if we are to draw any inference from the cases in tlie publica-
tion under review, were in a very favourable condition for operation. We
have long been of opmion that when the tumour is very moveable, the
constitution sound, the habit spare, and the mind resolute, a practitioner
may be sanguine of success ; and we do not consider ascites, if the general
health in other respects be good, a discouraging complication.
• Dr Churchill's Notes on Ovariotomy, Dublin Journal, No. Ixxv., July 1844.
DROPSICAL OVARIA. 321
Though from the foregoing obserTations it may seem that we are in
favour of this formidable operation, we wish, however, to be distinctly un-
derstood as considering it teught with danger ; that it should not be under-
taken without repeated consultations with men of judgment and experience,
nor without an accordance in their opinions that the tumour is ovarian,
that it is increasing in size, and that its connexions are neither numerous
nor extensive.
The attention in the after-treatment bestowed by Mr Walne on his
patients was beyond all praise. The first two bad been married ; their
ages respectively were fifty-eight and fifty-seven ; the first had had five
children and several abortions, but the second had never been pregnant
An unmarried lady of twenty was the subject of the third operation ; and
all three enjoyed good health. In all of them the iinea alba was chosen as
the seat of incision, which extended in each respectively thirteen, twelve,
and nineteen inches. The right ovarium was involved in the diseased moss
in the first patient, and the left oigan in the second and third casea. The
tumour in the first and third illustrations formed but one cyst, but the
pathological condition of the second is not stated. Except by its pedicle, the
growth formed no other connexion in any of the cases. In the first
example the greatest circumference of the tumour, taken horizontally,
was 2 feet 10| inches ; length, 2 feet 8 inches ; across, 2 feet 4 inches :
the tumour in the second case weighed 16| pounds; and in the third
patient, 28 pounds.* The ligature placed on the pedicle of the tumour in
one of the individuals separated ten weeks after operation ; and in another
of the cases it was detached in five weeks^ while the second ligature in the
same patient could not be removed until the sixty-eighth day after she had
been operated on. There was in the three patients a considerable degree
of gastric derangement and vascular excitement for some days after the
removal of the tumours ; and in one of them a slight attack of something
resembling phlegmasia dolens, which was subdued by leeches. In all,
opiates were exhibited after the patients had been put to bed ; the bladder
evacuated for some days by the catheter to prevent the wound being dis-
turbed ; enemata administei-ed when required ; and the antiphlogistic
regimen observed for a proper period. From the details it does not appear
that any of those cases were succeeded by ventral protrusions, as had
happened in some of the patients in whom we witnessed the operation.
From the tenor of the foregoing remarks, Mr Walne must acknowledge
our readiness to do justice to his merits ; but we ai-e also bound by our
duty to the public not to overlook his faults ; and we tlierefore regret to
observe that he should have been so far misled by his success in the present
instance as to indulge in a style so confident and dogmatic as might induce
some of his readers to believe that as an ovarian pathologist and operator
he has few if any equals. At p. 64, he goes on to state, that ^ a mistaken
idea prevails in some minds tliat the disease does not tend to shorten life,
nor to destroy its comforts. I shall hereafter show that this opinion is
totally at variance with facts. Like many other erroneous opinions, it is
repeated on authority by men whose position might easily enable them to
ascertain that it is devoid of truth. Compilers are apt to follow such men.
* In one of Dr Clay*B cases the abdominal incinion was 28 inches, and the
tumour weighed 73 pounds. — ^Dublin Journal, ib. Haller relates a case in which
the ovarian tumour with the uterus weighed lOO^ pounds. — Disputat. Med., tom.
iv. p. 449.
2s
322 DROPSICAL OVARIA.
How should they do otherwise ! They themselves, with few exeeptioiu^
are little engaged in the obseiration of disease, and cannot be expected to
fonn opinions, except upon the report of oth^^s. . . . Equally &alty
in fact and in tendency is the suggestion that the operation itself is neces-
sarily one of easy performance, requiring little anatomical knowledge, or
flikiliul surgical adroitness It is the possession of correct phy-
siological, pathological, and therapeutical knowledge that enables a practi-
tioner to cope with the real difficulties of operatire surgery, &c. ....
If to perform an operation so rapidly as to excite the astonishment of a
large class of staring students, &c. &c. &c. be mistaken for perfection id
the art of surgery, then indeed is it high time that such erroneous notions
should be corrected,'' &a
Without knowing who the compilerB may be that have incurred the cen-
sure of our author, we are very much inclined, after an experience of nearly
thirty years in a pretty extensive field of obserration, to concur in their
opinion. Cases of ovarian disease are by no means rare, and of a great
number in which we have been consulted, all except one were of protracted
duration ; and where the patients observed prudent habits, and could ab-
stain from undue exertion, the disease interfered very little, if at aU, with
the comforts of life for a long course of years. An individual is known to
us who enjoys good health, though now at the advanced age of sixty-four,
and though both her ovaries have been enlarged for nearly thirty years.
Our author would perhaps observe that such cases constitute the exception
to the general rule ; but, be this as it may, we can unhesitatingly reply that
such exceptions are numerous. Neither can we agree in the opinion, that
the removal of ovarian tumours requires much anatomical knowledge, or is
attended with difficulty, as is satisfiictorily proved, not only by a reference
to the cases of the author,but also to those of others ; for, as there is scarcely
any dissection necessary, so we have little to apprehend from the division of
important blood-vessels or nerves. The only difficulty which a practitioner
can encounter, and we speak from personal observation, is in forming a
correct diagnosis regarding the nature of the tumour, and in deciding on
the propriety of an operation ; but as these points would be settled by seve-
ral searohing consultations, we should consider the remaining duty an
easy task, and presence of mliid the principal qualification. The author
would wish his readen to believe that little importance need be attached to
the surgeon being able to use his instruments with rapidity ; but for our
own parts, we consider this a principal element in the qualifications of
an operator, for nothing surely can be mora painful than to witness the
protracted haggling of some of those toi-disant operators.
From the importance of the illustrations on which this little work is
founded, we have extended our observations considerably beyond our original
intentions ; and we now conclude by recommending tiie publication itself
to the notice of the profession, and trusting that the mora extended work
promised by the author will speedily make its appearance.
Trial of a Surgeon for Manslaughter: Case of Rupture of the VaginOy
and Laceration of the Intestines.
We copy, from the 19th No., Vol. I., of our respected contemporary, Th^
Provincial Medical and Surgical Journal, the following particulars of a case
RUPTURB OF THE VAGINA. 323
in obstetric practice, which is a diagrace, not so much to the profession as
to the legislature. Hitherto the proper authorities have withheld from a
most useful branch of the medical profession that protection to which it was
entitled, by fidling to make such wise emictments as would have compelled
candidates for public &vonr to show, by saUsfi^tory proofs, that they have
been instructed by properly qualified teachers, and by searcliing examina-
tions before competent judges, that they are correctly informed in the prin-
ciples and practice of their profession. It is never too late to do good ; and
the government have at last, in consequence of numerous and urgent repre-
sentations from various parts of the kingdom, been compelled to take the
pi-esent condition of medical pi'actice into consideration ; and we earnestly
trust that the department of Midwifery will receive that share of attention
to which it is entitled.
The subject of the case which has given rise to these remarks was a
healthy woman, fet. twenty-four, the mother of four children, all of whom
were produced during easy labours. On ,the 22d May 1844, when about
three months pregnant, and in the enjoyment of her usiial health, symptoms
of abortion were induced in consequence of her having lifted a body which
must have weighed at least 168 pounds. The following morning about
four o'clock, Mr Garland, the actor in the tragic scene which we are about
to describe, arrived. He introduced his hand into the sexual canal, and through
its parietes into the abdominal cavity, whence he dragged per vaginam 19^
feet of the small intestines. Mr Jones was now called, and deeming the
situation of this unfortunate victim of professional ignorance quite desperate,
he left her after liaving given some directions for palliating her condition ;
and strange to relate, sfie survived her cruel treatment seventeen days. This
case was recently before the judges and a jury at Cambridge, who con-
victed the practitioner concerned of manslaughter, and sentenced him to
the lenient punishment of one month's imprisonment in the county gaol.
We are afraid to trust ourselves in commenting on the foregoing case,
and what is more, our limits will not permit extended observations ; but
we promise our readers to recur to the subject. The delinquent must have
been utterly ignorant of the natural condition of the female reproductive
organs. There is not a student who has attended obstetric lectures with a
moderate share of diligence, but must have heard his teacher state, that the
introduction of the hand into the vagina dilated but an hour previously by
child-bearing, was attended with great uneasiness; and what roust the
feelings of the patient be when this canal is distended in early pregnancy by
the abrupt intrusion of the hand, without previous preparation by such a
process as parturition I
Among the causes which have contributed to some of the dlBtreasing
scenes that are occasionally witnessed in the lying<in room, we must not
omit to mention that criminal apathy which many of the pupils of a
class manifest during their attendance on obstetric instruction ; some of
them leaving the schools, and that too dignified with the title of M« D.,
without having attended a single labour case ; trusting to the confidence
inspired, by the license of a college, for future lame and support. But
if ignorance on the part of our junior members has led to painful con-
sequences, it is not less certiun that among veteran practitioners results
equally distressing have arisen from intemperance. In the Sheffield Iris,
July 10, 1836, and in the Chester Chronicle, October 6, 1838, cases
are reported in which a verdict of manslaughter had been pronounced by
a coroner's inquest against two piactitioneni who, while in a state of
324 MBNTAI. HTOIBXB.
inebriety, hj the rpckks use of inrtnimcnts raptmed the ntcnii snd
destroyed their pstients. Bot our leaden miiBt not mppose that aneh
dngiacefol scenes are acted only soaih of the Tweed ; mai^ hsre been
lekted to ns whidi happened nearer home, and one of these not long
since, where a Teteran practitioner, in a state of ezhilarationy pasaed his
hand throng^ the uterns, and brought down the intestines to a eoosiderabk
extent. The patient was in a ci^^cal state preriooaly, and after this dis-
treBBing enor die soon died.
Mental Hygiene, or an EMtmmaHon of (he InieBed and PauionM^ duUgnei to
iHuHraie their Infiuenee on Health and the Duration ofUfe, By Wiujam
SwEETSER, M.D^ Lite Professor of the Theory and Practice of Physic,
and Fellow of the American Academy of Arts and Scienee& Edinbnigb,
1844.
Tms work on Mental Hygiene is reprinted fiom the Amefiran edition. It
contains a great deal of good sense «hi some rety impmiant topiGS. It
abounds more in alladoos to general litetatare than is eonimon in profies-
aional works. This we should hardly regard as a &nlt on such a sobjeet,
evoi if the book were des^pMd to be confined to medical readers. But since
a treatise of this kind should be oonsideted less as a soaree of infiinnatkm
to medical men than as one to be reecMnmended by them to th^ patients
as enforcing SMne of the most important prec^tsforthe daOy maoagonent
<^ health, we look cm the disenrnve diameter of the book as an etsedknce
nther than as a finilt.
That medical men, as members of an hmoiirable profiessiony are boond in
dnty not merely fiiithfally to do their utmoat to cue disf aoi o when they
arise, but also to teach those who repose confidenee in them how to a^eit
ill health, we suppose to be a proposition to which all oarreaders will give
their nnqoalified aasenL
We are &r from advising that works on dincanns shonld be put into the
hands of non-medical persons ; than this hardly any thing can be more per-
iudon% whether we consider it in the Mght of the danger of a little know*
ledge when diopaofn actoally oocnr, or as a means of suggesting to seasitiTe
minds one of the most effiectoal of all the arts of adf-toanenting.
Bat to a work of the kind before ns being pat into the hands of sodireaden
there can be no objecticm. It tonchea on many tc^ics whidi the pablie are
qaite competent to jndge o^ and anggests many precepts which can only be
carried into effect by each individaal acting for himsplf. It would be easy^
to descant at length on the fertile topics ai^gested by oar author,— <m the
amount of misery and aouices of ill-health which indhridoals m^t save
ihemselTes from by some pains to acquire aelf4mowiedge in the early part
of life, and on the degree in whidi paraita voi^jaS^ contribute to leacue their
chOdren from suflfering in afto'-life by % more perfect knowledge of the
modes in which the fimnation of the mcxal and mtellectual dauacter is to
be swayed.
There can be no doubt that serious inroads both upon the present and
upcm the after health are committed by eirors whidi mi^t easily be
avoided in the conduct of education.
It is a prevalent fxtna to oommcnoe the school educatkm of ehildien too
early. We are not di^osed to objeet to infent-sehooh, as loqg as these are
confined to the diildren of the labouh^ovdeBof society, bceaose their
MENTAL HYGIENB. 325
education is to tenniiiaie sooner, so that their intellect is not to be subjected
to eontinaed exertion daring the whole period of the derelopment of the
bodily firamey and also because^ when the parents are engaged all day in
labour, the children are better taken care of in sach schools than they could
be at home.
But when the education of literature or of aocomplishment is to be carried
on through a long period of years, it stands to reason and is confirmed by
experience, that to begin any kind of instruction by letters before six or
seven years of age is not merely hurtful to the health, but defieats the object
intended by it.
There is a self-education which every child must go through, the greatest
and most momentous part of which takes place at a period antecedent to
the date of the memory in after-life. Daring this period the infant must
be employed in the most important mental processes, founded on the acute
observation of every thing which fiiUs nnder the cognizance of sense. And
even after that portion of the intellectual life has begun which, by the
agency of memory, is to be coextensive with the life of the body, the mental
operations of the child are still distinguished by the predominance of an acute
observation of external things. This is, in short, the period for the training
of the senses to that degree of perfection which is to mark them in the in-
dividual throughout after-life. The assistance, therefore, which should be
given to the child at this important stage of his progress is merely the
placing of him amidst objects such as it is desirable he should be minutely
acquainted with for his after-pursuits. To engage him in books at this
time is to withdraw his attention from the study of things — ^to blunt his
senses in a way that can never afterwards be compensated for, — ^in short, to
injure his intellect and to risk his health without any corresponding ad-
vantage. For the child who begins his letters at six years of age quickly
overtakes him who began at three.
Let us hear our author on this subject. — *^ Premature and forced exer-
tions of the mental faculties must always be at the risk of the physical
constitution. Parents, urged on by an ambition for their intellectual
progress, are extremely apt to overtask the minds of their offspring, and
thus, too often, not only defeat their own aims, but prepare the foundation of
bodily infirmity and early decay. Such a course, too, is repugnant to the
plainest dictates of nature, to be read in the instinctive propensities of
the young, which urge so imperiously to physical action.
*^ Exercise, in early existence especially, is a natural want, being then
essential to train the muscles to their requisite functions, and to ensure to
the frame its full development and just proportions. So strong, indeed, is
this tendency to motion, that few punishments are more grievous to child-
hood than such as impose restraints upon it. The young, in fact^ of all
animals of the higher orders, equally display this necessary propensity.
Liberate the calf or the lamb from his confinement, and what a variety of
muscular contractions will he not immediately exhibit in his active and
happy gambols ! He is herein but discovering the instincts of his nature,
just as much as while cropping the grass and herbage. In tasking, there-
fore, the functions of the brain, and restraining, consequently, those of the
musdes, in early life, we act in contravention to the most obvious laws of
the animal constitution.
** I would not, however, be understood to say that the powen of the
mind are to be absolutely neglected at this period. They are certainly to
be unfolded, but then prudently, and in just correspondence only with
326 MENTAL HYGIENE.
the development of the physical organization. To look for ripeness of
intellect from the soft, delicate, and immature brain of childhood, is as
unreasonable as it would be to expect our trees to yield us fruit while
their roots were unconfirmed and their trunks and branches succulent.
" * Nature,' says Rousseau, * intended that children should be childi-en
before they are men, and if we attempt to pervert this order we shall pro-
duce early fruit, which will have neither maturity nor savour, and which
soon spoils : we shall have young learned men, and old children. Infancy
has an order of seeing, thinking, and feeling, which is proper to it.
Nothing is more foolish than to wish to make children substitute ours for
theirs, and I would as soon require a child to be five feet high, as to dis-
play judgment at ten years of age.'
<* But, independent of the danger to the physical constitution, nothing
is in reality gained as respects the intellect by such artificial forcing. On
the contrary, the energies of the mind being thus prematurely exhausted,
it seldom happens that these infimt prodigies, which raise such proud
hopes in the breasts of parents and friends, display even mental medio-
crity in their riper years. In some cases insanity, or even idiocy, has been
the melancholy result of such unnatural exertion of the organ of thought
while yet delicate and unconfirmed.
" Furthermore, those even whose minds naturally, or independent of
education, exhibit an unusual precociousness, rarely fulfil the expectations
they awaken. Either falling the victims of untimely decay, —
* So wise so young, do ne'er live long,*
or else reaching early the limit of their powers, they stop short in their
bright career, and thus, in adult age, take a rank very inferior to those
whose faculties were more tardy in unfolding, and whose early years were
consequently less flattering. That mind will be likely to attain Ih
greatest perfection, whose powers are disclosed gradually and in due cor-
respondence with the advancement of the other functions of the constitu-
tion. It is a familiar fact that trees are exhausted by artificially forcing
their fruit ; and also, that those vegetables which are slow in yielding
their fruit, are generally stronger and more lasting than such as arrive
earlier at maturity.
" ' We have frequently seen in early age,' observes a French writer on
health, * prodigies of memory, and even of erudition, who were, at the
age of fifteen or twenty, imbecile, and who have continued so through
life. We have seen other children, whose early studies have so enfeebled
them, that their miserable career has terminated with the most distressing
diseases, at a period at which they should only have commenced their
studies.' — Tourtelle.''
One serious evil of overtasking the mind towards puberty is especially
observed in females, in whom, from this cause, the function of the uterus
proper to that age is imperfectly developed. Our author does not touch on
this subject, though in our opinion it is one to which the attention of
parents cannot be too strongly drawn.
The following passages contain some useful observations : — *^ The capa-
bilities of the mind, like those of the body, must necessarily have their limits,
and are hence liable to be overtasked. The powers of the brain may be
impaired by extravagant mental, in like manner as those of the muscles by
severe corporeal exertions. And then so close are the sympathetic relations
between mind and body, that whatever serves to injure the former, must
MENTAL HYGIENE. S27
at the same time put in hanrd the wetfiare of the latter. Hence, if the
intellectual fiicolties are hahitaally overstrained, a train of moral and phy«
sical infirmities may he induced which shall imbitter existence and abridge
its dniation.
*^ Persons who addict themselYes immoderately to intellectual pursuits be-
come exposed to affections of the brain, or organ especially abused. They
are liable to headachs, and an indescribable host of nervous ailments. In-
flammation, too, and other organic diseases of the brain will sometimes
supervene. And, as they advance in life, apoplexies and palsies are apt to
assail them. Whenever there exists a predisposition in the physical con-
stitution to apoplexy, close mental application is always attended with the
utmost hazard, and more particularly so after the middle term of life.
** Epilepsy is another melancholy disease of the nervous system, which
a highly active and exalted state of the mind would seem to favour. Many
individuals, distinguished for their talents and mental efforts, have been the
subjects of this unhappy malady ; as, for example, Julius Cesar, Mahometi
and Napoleon. And among learned men, Petrarch, Columna, Francis
Rhedi, and Rousseau, are familiarly cited instances. Still, in these cases
how much may be justly ascribed to the abstract labour of intellect, and
how much to mental anxiety, or the undue excitement and depression of
the moral feelings, cannot be certainly determined.
'< Extreme mental dejection, hypochondriasis, and even insanity, parti-
cularly if there be in the constitution any tendency to such conditions, may
sometimes result from the cause I am considering. And in occasional
instances, under their intemperate exertion, the energies of the brain have
been consumed, the light of intellect has become extinct, and in a state of
mental imbecility, or even drivelling idiocy, the wretched victim has been
doomed to linger out a pitiable existence within the walls of a madhouse.
** I have thus stated what may occur in extreme cases from abuse of the
intellectual powers. Still I conceive that the diseases of literary men are
far oftener to be imputed to incidental circumstances, as their sedentary
habits, injudicious diet, &c., than to their mere mental labours ; and tliat
would students, or those whose avocations draw especially on the energies
of the mind, but bestow the requisite attention on their regimen of life,
they mighty as I have before said, enjoy as good and uniform a share of
health as most other classes of the community.
^ Among the rules of health most essential to be observed by those
whose pursuits belong more especially to the mind, we may in the first
place mention temperance both in eating and drinking. Persona of stodioua
and sedentary habits neither require, nor will they bear, the tame amount
and kind of food as thoee whose oocnpations call forth greater physical ex^
ertion, and produce, consequently, a more rapid consumption of tlie mate-
nak of the body. If such, therefore, will persist In eating and drinking
like the day-labonier, they most look to experience indigestion^ and all Us
aggravated tnm of misoies. Or, eren shoold they escape dyspepsia^ the
yet gnver ills of exeessire lepletion, as infUmmatkna atad eoDgeetiona, will
be likely to overtake them.
'^ It is important^ too, tliai a certain degree of r^golarity be observed In
reject to their meals^ the etODBaehy like erety other cfpm of the animal
economy, being sobjeei to the inflaenee of hatitt ; uad Hukdurinff them the
mind be withdnwn aa modi as possible from all other etmeenm, md mter-'
ested c^ecially in the agieeaMe seoiaal imynmom H w expmammf^
TheeojoymeiitoroiirlMMifofinioiieof the best of isiM«i lor tJie frnMno-
tionofiU4
328 MENTAL HYGIENE.
** Eating, furthermore^ being an imperious animal duty, suiEcient time
should always be appropriated to its performance. The habit of rapid
eating is exceedingly common among studious men, and is very apt to be
acquired at our colleges and boarding-schools, the inmates of which often
despatch their food more like ravenous animals than civilized human crea-
tures. This most disgustingly vulgar practice of goiging our food but half
masticated, — of hurrying through our meals as though we were just going
off in the stage-coach, — I believe to have more concern in the production
of Indigestion among us than has generally been suspected. We are told
that Diogenes, meeting a boy eating thus greedily, gave his tutor a box on
the ear ; and abo that there were men at Rome who taught people to
chew as well as to walk. Whether some such teachers might not be ad-
vantageously employed among ourselves, I submit to the judgment of my
readers.
'< There are a class of men who, under an affectation of moral and intel-
lectual refinement, assume to regard eating as one of those base animal
gratifications to which as little time and thought as possible should be ap-
propriated. But let us remember that we yet dwell in the flesh, and can-
not, therefore, become wholly spiritualized. Those actions which nature
has enjoined as necessary to our constitution, are fortunately — and, in-
deed, the species, with its present laws, could not otherwise have been pre-
served — associated with enjoyment. It is the part of wisdom, therefore,
not to despise, neither slavishly to pui-sue, the corporeal pleasures^ but to
accept of them with thankfulness, and to partake of them with prudence.
The gratification of all our appetites contributes, both directly and in-
directly, to health and happiness ; it is their abuse only that is reprehensible,
and followed by pam and regret. How many delightful associations, how
many springs of domestic enjoyment, flow from the regularly returning social
meal — an occasion which brings into so near and happy intercourse families
and friends, and serves to draw more closely among them the bonds of human
afiection. He alone who has been deprived of such pleasure can rightly
estimate its value. A purely intellectual being would be monstrous to
humanity. There belong to our nature, sensual, moral, and intellectual
wants, and it is to their wise and duly apportioned gratification tliat we
owe whatever happiness existence can a^rd,
'* It is scarcely necessary, I trust, to insist on the importance to the health
of intellectual men, of daily exercise in the open air. Without this, no
one whose employments are of a sedentary nature can expect to maintain
sound health. The amount of exercise required will depend something on
the constitution, and much on the character and quantity of the food.
From two to four hours of the day should certainly be devoted to active
bodily exertions.
'< Many students, tempted on by the inviting quietude, are in the habit
of protracting their labours late into the hours of the night, and at the mani-
fest expense of their physical health. The wan and sallow countenance
of the student is almost proverbially associated with the midnight lamp.
" Few causes tend more certainly to shatter the nervous enei^ies, waste
the constitution, and hasten on the infirmities of age, than deficient snd
irregular sleep. Thus, * to be a long and sound sleeper,' we often find in-
cluded by the older writers among the signs of longevity. Those persons
whose occupations — ^whatever may be their nature — interfere with their
necessary and regular repose, are almost always observed to be pale,
nervous, and emaciated. Even a single night of watching will often drive
the colour from the cheek, the expression from the eye, and the vigour
MEN-TAL HYGIENE. 329
from the br^. Although so much of evil to mind, body, and estate is
referred to the prodigal indulgence in deep, yet observation of our own
busy and ambitious commnnity has led me to doubt whether, on the whole>
more injury is not to be ascribed to its deficiency than excess. Nor do I
hesitate to believe that less evil would result, certainly to health, from
adding to than curtailing the needful term of repose.
** Constitutions will necessarily vary in the amount of sleep they require,
but, in the majority of persons, as much as seven hours of the twenty-four
should be appropriated to it. The slumbers of the fore-part of the night
affording, as there is good reason to believe, most refreshment to the func-
tions, it is advisable that students retire and rise seasonably, and accom-
plish, if circumstances will permit, their nK>st arduous duties in the early
portion of the day ; for this is the time, if the body is in health, when the
thoughts will be generally most clear, and the labours consequently most
profitable. The fittest working hours, in fact, both for mind and body,
would seem to be those which intervene between breakfast and dinner,
having reference, of course, to our own customary hours for these nienls.
It is the stillness and seclusion of the night which have mostly rendered it
80 fiivourite a period for study and contemplation.
" Again, men of intellectual application should frequently relax their
minds by amusing recreation — ^mingling in cheerful society, and joining
in its gay diversions ; otherwise they are apt to become gloomy, irritable,
and misanthropic, — states of feelmg which are always at enmity with our
physical well-being. Let them unite, therefbre, in the laugh, the game,
the dance, or any of the innocent frivolities of society ; the dignity of the
most erudite and talented need not suffer in consequence, while the health,
from the moral exhilaration thus procured, will be sensibly benefited. It
is certainly worthy of inquiry, if the learned and distinguished of the
present day, or at least among ourselves, do not cherish an undue contempt
for the light and healthful amusements of society, and thereupon unreason-
ably exclude themselves from their participation. Among the ancients the
greatest souls did not disdain occasionally to unbend, and yield to the laws
of their human condition. The Catos, with all their severity of manners,
found relaxation and enjoyment in the ordinary pleasures of life. Epam*
inondas, amid all his glory and moral greatness, felt it no detraction to
danee, cmd shig, and play with the boys of his city. Scipio Africanus could
also amuse himself in gathering shells, and playing at quoits on the sea-
shore with his fi'iend Lslius. And the sage Socrates became the pupil of
the captivating Aspasia in dancing, as well as in eloquence, even when he
was advanced in life. Montaigne, after extolling the mighty intellect and
lofty virtues of Socrates, his patience and forbearance under poverty,
hunger, the untractableness of his children, and the scratches of his wife,
concludes by saying that * he never refused to play at cobnut nor to ride
the hobby-horse with the boys.' — Essays,
*' As a pure air not only serves to invigorate and sustain the body, but
likewise to animate the mind, literary men should always choose for their
studies, where so much of their time is passed, a large and airy room. The
narrow and confined apartments which many select for the prosecution of
their mental labours can scarcely be otherwise than imwholesome.
** Different individuals, as we should naturally conclude, vary materially
in their capability of supporting mental exertions. This may in some cases
be referable to habit, and in others to the native strength or feebleness of
tlie constitution in general, or of the organ of thought in particular. To
2t
330 MENTAL HYGIENE.
some persons mental application is always irksome ; the task of thinking
is the most unwelcome one that can be imposed on them. While in othen,
just the reverse is obeenred ; the intellectual operations are ever accom-
plished with ease and satisfaction, and to the new results of their studies
and reflections do they owe the purest delights of existence. In the latter,
then, the exercise of mind, being less arduous, and associated also with a
pleasurable excitement, will be far better sustained than in the former.
" I may here remark, what indeed must be obvious to all, that we can
form no correct estimate of the absolute amount of mental labour in dif-
ferent individuals from what they accomplish. For, as the giant in body
may support his three hundredweight with as little effort as the dwarf his
one, so also may the gigantic intellect produce its astonishing results with the
same ease that the less gifted mind performs its comparatively insignificant
tasks. Many a poetaster has doubtless worked as hard to bring forth a
volume of doggerel verses, as Newton did in the production of his Prin-
cipia.
^ In relation to the period of time that may be safely and profitably
devoted to study, we can lay down no rules which will be universal in
their application. Few persons, however, can spend advantageously, and
without hazard to the physical health, more than seven, or, at the furthest,
eight hours of the twenty-four, in close mental application. As the brain
grows weaiy its capabilities must diminish, and its productions, in conse-
quence, be comparatively feeble ; whence tiiey are said to smell of the
lamp. Having then r^ard only to the intellectual results, nothing is
really gained by overtasking the mind. It has been truly remarked, that
' there is scarcely any book which does not savour of painful compositioii
in some part of it ; because the author has written when he should have
rested."*
On the subject of the influence of the passions over the bodily healtb,
we quote the following passages : —
** The i^ency of the passions in the production of disease, especially ib
the advanced stages of civilisation, when men's relations are intimate, and
their interests dash, and their nervous susceptibilities are exalted, can scarce
be adequately appreciated. It is doubtless to this more intense and multi-
plied action of tiie pasaons^ in union, at Umea^ with the abuse of the intel-
lectual powers, th^ we are mainly to attribute the greater frequency of
djaeaacs of the heart and brain in the cultivated than in the ruder states of
society. Few probably even suspect the amount of bodily infirmity and
disease among mankind resulting finom moral causes ; — how often the frame
wastes^ and premature decay comes on, under the corroding influence of
some painful passion.
** It has seoned to me that our own profession, in seeking for the remote
occasions of disease, are too a;pt to n^lect those existing in ^e mind. Thus
does it oftentimes happen that, while the physician is imputing the infinn-
ities of his patient to all their most familiar causes;, as bad die^ impure air,
want of exercise^ &c., it is in reality scnne unhappy and unrevealed pasaon
which is preying on the ^rings of life. A knowledge of the secret troubles
of our patients would, in many instances, shed new light on their treatment,
or save them at any rate firom becoming the subjects^ if not the victims, of
active medicinal agents.
** In delicate and sensitive constitutions, the operation of the painfiil pas-
sions is ever attended with the utmost danger ; and should there exist a
predisposition to any particular form of disnae, as ooosumption or insanity
MENTAL HYGIENE. 331
for example, it wUl generally be called into action under their strong and
continued influence.
" The passions, however, although so greatly abused, and the occasion of
so large a proportion of the ills from which we are doomed to suffer, yet,
when properly trained, and brought under due subjection to the reasoning
powers, are the source of all that is great and good in man's nature, and
contribute in a thousand ways, both directly and indirectly, to health and
happiness. Intellect, without their quickening influence, even could it
exist at all, would be but a dull and dreary waste. They are the sunbeams
which light and cheer our moral atmosphere. The greatest achievements
are always accomplished by those of strong passions, but with a correspond-
ing development of the superior faculties to regulate and control them.
Sluggish feelings can never be parents to high and generous resolves. It
belongs to us, then, to govern, and direct to their proper ends, through the
force of reason, the passions which nature has implanted in our breasts.
They cannot, nor is it desirable tliat they should, be extirpated.
* When Reason, like the skilful charioteer,
Can break the fiery passions to the bit.
And, spite of their licentious sallies, keep
The radiant track of glory ; passions then
Are aids and ornaments. Triumphant Reason,
Firm in her seat and swift in her career.
Enjoys their violence ; and, smiling, thankjs
Their formidable flame for high renown.*
Young,
*^ Mankind, owing to original differences of constitution or temperament,
vary remarkably in the ardency of their feelings. The external physical
characters will, in fact, often indicate pretty dearly the native force of the
passions. Who, for example, would not at once distinguish, even by the
complexion, the sanguine or warm and excitable, from the phlegmatic or
cold and passionless !
" Incidental circumstances acting on the constitution will likewise influ-
ence the strength of the passions. Thus, the inhabitants of tropical coun-
tries are more apt to be hasty and violent in their feelings, and consequently
to become enslaved to their sensual and animal nature, than those who
dwell in colder climes. Indolence and free living will also aggravate, and
activity and temperance weaken, the operation of the passions.; hence there
are few better antidotes to their ungovernable violence than simple food and
drink, and bodily labour.
^' In some persons the animal or baser nature would appear constitution-
ally to predominate, the passions readily breaking from the control of reason
and the will, and bringing too often sorrow, shame, and disease upon the
unhappy individual. In others the reverse of this is true ; the intellectual
nature holding the supremacy, ever keeping the feelings under a just re-
straint : and fortunate indeed are they
' Whose blood and judgment are so well commingled.*
" Some, agam, seem naturally characterized by the good, and others b}*"
the evil passions. We meet individuals, not often it is true, yet we do
meet such, in whom the amiable affections maintain a distinguished pre-
eminence even from the earliest development of their moral nature. They
appear predestined to be good. Their placid and benevolent tempers would
seem to be the result of a physical necessity, or of some happy but partial
332 MENTAL HYGIBNB.
action of creative power. Such, however, are exceptions to the general
laws of the species, and are consequently never perpetuated. But here the
-question will necessarily arise, Can we ascribe any virtue, any merit, to
.such innate goodness, to such constitutional amiableness ! Virtue is essen-
tially active. It is engendered out of the contentions between the generous
and noble, and the base and despicable passions of the soul. Its very exis-
tence depends on the successful struggle with our evil dispositions. Chastity
would be no virtue m one without carnal desires, nor clemency in him who
was incapable of hatred or anger. The poets glorify their gods by making
them war with demons. As the artist heightens and sets off the bright and
beautiful colours of his canvass by the dark shades with which he inter-
mingles and contrasts them, and exaggerates the beauty of his angels through
the ugliness of his devils, so does nature, on her mond canvass, enhance the
lustre and comeliness of virtue by the very shadows and deformities which
she throws into the picture. Hence, on the commonly received notions of
the character of God, — as I have somewhere met the idea, — although we
may call him good, great, just, bountiful, yet we cannot call him virtuous ;
for his goodness demands no effort, — ^no sacrifice ; it belongs to his very
essence ; is as natural to him as it is to the flower to shed its odours, or the
sun its luminous rays.
** As the good passions greatly preponderate in some natures, so do the
bad in others ; and we meet those who scarce ever, even from their child-
hood, manifest an amiable or generous feeling. Such extreme cases^ how-
ever, are fortunately but rare. Generally there exists in our composition a
due mixture of the good and evil dispositions : — ' our virtues would be
proud if our &ults whipped them not ; and our crimes would despair if
they were not cherished by our virtues.*
^* Finally, there are those who, from early existence, are distinguished by
the predominance of some particular passion, as fear, anger, or ambition;
that is, they are constitutionaliy timorous, irascible, or aspu-ing in their
tempers. Education, however, may do much, very much, in repressing
passions originally in excess, and developing such as are deficient ; and
herein consists moral culture, so vitally essential both to our health and
happiness. Need I say, then, how much we must be the creatures of con-
stitution and circumstance 1 how much of what we are we must owe to our
native organization and predispositions, and those resistless influences which,
in the necessary current of events, are brought to act upon us !
" I am aware that such views as the preceding will be objected to by
some as inconsistent with the freedom of our will, or as tending to the
doctrine of necessity, of which many appear to entertain such needless ap-
prehensions. That we belong to some vast system, the grand purpose of
wliich is hidden from human intelligence, will scarce be gainsaid ; and that
our every volition and action may be but infinitesimal and necessary links
in the mighty and complicated chain of this great and unsearchable system,
it is not irrational to believe. But as I pledged myself in the outset to
shun all abstract speculations, I will leave this perplexed subject of fatalism
with the remark only, that there was true philosophy in that ancient mar-
iner who, being caught in a great storm at sea, exclaimed thus to Neptune :
' — * O god, if it is thy will I shall be saved !— and if it is thy will I shall be
destroyed ! — ^but Fll still steer my rudder true.' *'
We take the following passages as specimens of our auth(H:'s mode of
treating of the particular passions.
** Having learnt in the pi-eceding chapter how severe and dangerous are
MENTAL HYGIENE. 333
4he effects of acute anger on the vital economy, it will excite no surprise
that under its more chronic action, as in habitual irritability or fretfulness .
of temper, enmity, hatred, revenge, or other malevolent feelings, as envy or
jealousy, in which anger, to a greater or less degree, is almost necessarily
blended, the bodily health should sooner or later experience a baleful influ-
ence. The constant torture of mind kept up by such unhappy feelings
cannot but be attended with the most deleterious consequences to the phy-
sical economy. In the stomach and liver their effects are early and parti-
cularly evinced. Thus will the appetite and digestion become impaired,
and tlie hepatic secretion be variously disordered, and sometimes partially
or even wholly obstructed, when the bile, being absorbed into the system,
taints the complexion with that dark and bilious hue which is so character-
istic of an unamiable or malignant temper. Hence the common expression,
to turn black with anger, hatred, or revenge, may have originated in correct
observation. It is a literal truth, although expressed in poetry, that one
may
* creep into the jaundice,
By being peevish.'
^ Irritability and moroseness of temper may also cause various inflam-
matory and nervous complaints, and such, more especially, to which there
is any tendency in the constitution. Thus gout, rheumatism, hysterics,
nervous headachs, and other nervous pains, as tic douloureux, are very apt
to be excited, or their fits to be renewed, under such prejudicial influence.
** Nothing, certainly, can be more desfrable, both in respect to our moral
and physical health, than a quiet resignation to the fiate decreed us. Fret-
tmg and repining under unavoidable evils only adds to their burden, and to
the eye of true philosophy shows a temper about as inconsistent as that ex-
hibited by the heathen world in flagellating their gods for the calamities
befalling them.
** The condition of temper now occupying our consideration is in a par-
ticular manner injurious when the system is labouring under disease. It is
well known to every observing physician, that fractious patients, other cir-
cumstances being the same, recover less promptly, and are more exposed to
relapses, than those who display greater calmness and resignation in their
sufferings. And equally familiar is it to the surgeon, that under a bad state
of temper, wounds heal less kindly, and when recently healed will even at
times break out afresh. Likewise, that external inflammations pass less
safely and regularly through their restorative processes, and that the pus of
abscesses may be speedily transformed from a healthy to a morbid condi-
tion under such unfriendly moral agency.
. ** How important, therefore, it is, even if we consider but our physical
welfare, to cultivate, as far as in us lies, an amiableness of temper, and to
bear the little ills and crosses of life with all possible composure, must now
be most apparent. It is, after all, the minor evils, the trifling annoyances,
or such as tend merely to rufile or fret our feelings, that are apt to be the
least resolutely supported, and that oftentimes do more to mar our happi-
ness^ and impair our health, than even the absolute and severe afflictions of
life. Many of us who would be impatient under the pricking of a pin,
might submit with scarce a tremor or complaint to the most important and
painful operation.
^* The immediate and distressing physical effects of this mental irritation
may be especially noted in those of a nervous or sensitive temperament,
when disturbed on retiring to rest by unseasonable noises, as the barking of
334 MENTAL HYGIENE.
dogSy crying of children, thmmming of pianos, &c. Under sach vexing
circumstances, the action of the heart often becomes unnaturally accelerated,
and every pulsation of it most painfully sensible. A disagreeable dryness,
too, is commonly experienced in the mouth and throat, with feverishness,
sometimes itching of the skin, and a general nervous agitation, or restless-
ness, &r more intolerable than any definite pain of body ; and the
health, as might be expected, remains disturbed through the whole of the
subsequent day. Under the condition described, the nervous sensibility
will sometimes become so morbidly exalted, that the slightest sounds, as
even the ticking of a clock, will be almost insupportable."
We take our leave of this work, in which we have felt a very considerable
interest^ with the following passage from the concluding chapter : — *^ I have
stated, as my readers will remember, in the first part of this volume, that
the exercise of the intellectual functions^ abstractedly considered, does not
tend on a general principle to fiivour disease or shorten life. Yet sometimes
simple intellectual labours may be prosecuted to such excess as to occasion
manifest injury both to the moral and physical constitution. On examin-
ing the reports of different lunatic asylums, we shall find, in almost all of
them, some of the cases attributed to excess of study, I am satisfied, how-
ever, that a larger share, both of mental and bodily ills, than is in accord-
ance with rigorous truth, is referred to immoderate exertion of the intellect,
the reasons of which error have been previously explained. Thus, our in-
tellectual efforts are at the present day almost always associated with those
habits of life, as undue conifinement, insufficient and irregular sleep, and
other like incidental circumstances, which are well known to be inimical to
health. And furthermore, as knowledge is seldom pursued for its own
sake, but for some ulterior advantage, either of fame or pecimiary profit,
mental labours are rarely unaccompanied with the workings, too often the
strong and painful workings, of passion. Intellectual men, it must be ac-
knowledged, are, either by nature or (the force of circumstances, particular!/
prone to ambition, and are consequently exposed to all those evils and sof-
ferings heretofore described, which attend upon this passion when it becomes
a ruling principle in the human breast. If moderate and obedient to rea-
son, and its aims guide^ by wisdom, it may, as I have previously said, serve
as an incentive to call intp useful and wholesome exertion the different
powers of our nature ; but when inordinate, as it is unhappily but too apt
to become, then will feelings of the most painful and destructive character
inevitably grow out of it.
" Our own literary and scientific men, those of the learned professions
for example, will afford ample illustration of the truth of the above re-
marks. How restless, oft^n, and anxiou9 are their struggles in pursuit of
a little ephemeral notoriety ! To what various expedients do we not see
them resorting for the sake even of that brief and equivocal fame derived
through the columns of the periodici^ press ! But then, as the flattery of
success may not id ways reward their endeavours-; as they may merit the
shafts of censure where they looked for the .blandishments of praise ; too
frequently must the painful and .noxious passions, born of defeated hope
and wounded pride, as anger, hate, jealousy,. grief, humiliation, take pos-
session of the SQul, marring all life's n^oral peace, and calling forth a host
of physical ills, as indigestions, nervous disorders, palpitations, and all
sorts of irregularities of the heart's action, burdening, existence and abbre-
viating its term.
ALIMENTARY SUBSTANCES. 335
Part IIL— PERISCOPE.
ANATOMY AND PHYSIOLOGY.
Physiological Researches upon Alimentary Substances, By MM. C. Bernard
and Barresroill.
These gentlemen pointed ont in a work they lately published a simple and
very easy process, by means of which alimentary substances might be dis-
tinguished from non-alimentaiy substances. This process consists in dis-
solving the substance to be examined in gastric juice, and then injecting the
solution so prepared into the jugular vein of an animal. By this process
an artificial chyme is formed of known strength and composition, which,
being introduced directly into the blood, may be followed through its
several subsequent transformations.
If the substance acted upon in this way be assimilable, i. e., if it is ali-
mentary, it soon entirely disappears from the blood, and no trace of it can
be discovered in any of the secretions.
This, for example, is the case with sugar and albumen, substances which
are completely assimilable when they have been injected into the veins
after being di^lved in gastric juice. If, however, these materials be dis-
solved merely in pure water and injected into the venous system, they will
be found unchanged in the blood and urine.
If, on the contrary, we use in a similar way materials which are not as-
similable, these substances do not disappear from the blood, and even where
they are dissolved, in any proportion, in gastric juice, or any other vehicle,
they are always found imchanged in the blood and the excretions. Such,
for example, is the case with the prussiate of potass, which is always to be
found unchanged in the urine. These results now mentioned, and which
have been produced upon substances artificially digested, are exactly similar
to those pi^uced upon substances naturally digested and introduced into
the venous system by means of the lacteal vessels. For in this case as in
the former, the authors have never been able to find sugar or albumen,
which they had introduced into the stomachs of dogs, in the urine ; whilst
prussiate of potass, so introduced, was invariably found, and that in full
quantity.
The conclusion drawn by the authors from these and other observations
of a similar kind is, that all alimentary substances which have been dis-
solved in gastric juice, whether artificially or not, disappear in the blood,
and are not to be found in any of the secretions ; the opposite being the
case with all non-alimentary substcmces.
In illustration of what has now been stated, we give the following com-
parative experiments made by the authors upon dogs with sugar, albumen,
and gelatine.
The jugular veins of three young healthy dogs were opened : into the
first an aqueous solution of cane sugar was injected ; into the second an
aqueous solution of albumen ; and into the third an aqueous solution of
gelatine. No accident took place during the performance of these operations.
Three hours afterwards the urine of each dog was examined separately.
Sugar was found unchanged in the urine of the first dog ; in the urine of
336 ALIMENTARY SUBSTANCES.
the second dog albumen was found ; and in the urine of the third dog the
presence of gelatine was proved in a most satisfactory manner. Thus
sugar, albumen, and gelatine, injected without being dissolyed in gastric
juice, were found in three natural states in the urine.
The same substances, and in equal quantities, were dissolved separately
in fresh gastric juice extracted from the stomach of a dog. The substances
were then injected into the veins of other three young healthy dogs in the
same way as in the former instance. The urine was likewise examined
three hours after these operations, when no sugar was found in the urine
of the first animal, nor albumen in the urine of the second animal, but in
the urine of the third, gelatine was found as distinctly as it was in the
urine of the third animal of the former series of experiments.
To give more certainty to the last-mentioned experiments, the authors
made similar trials upon themselves. They took alternately a little sugar,
albumen, and gelatine. They w^ere unable in any instance to detect the
presence of sugar or albumen in their urine, whilst they invariably found
gelatine in it upon examination. From these experiments they conclude,
that gelatine is a non-alimentary substance. — Journal de Pharmacie et de
Chimie, Juin 184i.
SURGERY.
On the Remofjal of Encysted Tumours from the Eyelids,
The following extract from one of Mr Liston's Lectures, as reported in the
Lancet for June 29, we are induced to transfer to the pages of our Journal,
on account of the very valuable hints which it gives for the removal of
those troublesome tumours or cysts which are found so frequently
forming in the eyelids, and which are often a source of much annoyance
both to the patient and to the practitioner. The plan which Mr Liston
recommends of puncturing them from the inside, squeezing out their
contents, and then breaking up the cyst with a probe, is the one which we
most generally adopt ourselves, and we have very seldom found it to &iL
It is not oflen that we find the tumour returning again, when the cyst is
well broken up ; but when it does» it is only necessary to open it again,
and introduce either a fine point of the nitrate of silver, or a small portion
of caustic potass, as Mr L. advises, and in a sliort time all traces of the
disease have disappeared. This mode of treatment is, however, only
adapted for the removal of tumours which are attached to the inner
surfiace of the tarsal cartilage ; when they are situated on its outer sur&ce,
it is then necessary to remove them by an opening through the skin, and
if possible dissect them neatly out. This operation requires some little
care and dexterity, for as the eyelid is veiy thin, we run a risk of cutting
through it altogether, and injuring the globe, or we may make an
opening like a button-hole in the tarsal cartilage, which will not heal up,
and which will cause much disfigurement to the patient.
" In the first place, then, you will have now and then forming, in the
upper lid especially, small tumours. I do not mean to tell you about a
sty — a trifling, though painful enough, little abscess of the edge of the
eyelid, but a chronic swelling. There is a projection of part of the upper
lid and a trifling discoloration; sometimes there is more than one,* and
these, in young females more particularly, must be looked to in conse-
quence of their causing a great deal of deformity. In examining a case
of that kind, you evert the lid, take hold of the eyelash, and, as common
REMOVAL OF ENCYSTED TUMOURS FROM THE EYELIDS. 337
people would say, turn the eye inside out. You thus expose the inner or con-
junctival surfiEu^e of the upper lid. These tumours now and then, though
rarely, occur in the lower lid, but more frequently in the upper, and sometimes
they seem to form in the very substance of the cartilage of the tarsus. The
tamour consists of a thin cyst, containing a glairy fluid. Sometimes it becomes
inflamed, and there is a little puriform matter in the cavity. It is desirable
to get quit of these swellings. You would not make an incision on the outside,
for it would create some deformity, although a clean division made of the fibres
of the orbicularis palpebrarum muscle, in a right direction, would not pro-
bably be noticed after a time. You evert completely, as I have said,
the eyelid. But it is better to operate from within, and you thus expose
the tumour, the parietes of which are generally exceedingly thin. You
have only, then, to open the cyst. You make a crucial incision with the
point of a lancet, or a fine bistoury, or a small keen cutting knife of any
kind. You must not on any account attempt to dissect out the cyst ; for
if you do, the probability is you will make an opening like a button-hole
right through the lid. There is no means of taking away the cyst ; it is
80 exceedingly delicate and so incorporated with the substance of the lid.
You must endeavour, however, to get rid of the disease. There is, by
the way, one great difficulty in everting the lid in the living body. You
may fail in the first instance, and be under the necessity of using a probe.
You lay on the probe behind the cartilage, cant the cartilage over, and
turn the lid inside out. But with a little practice and a little dexterity
you will be able to turn the lid out without any such contrivance or
assistance, by merely taking hold of its edge, and using a slight motion
with the point of the forefinger. You will be under the necessity of
turning the eyelid over thus, in many cases, in order, for instance, to
discover and remove foreign bodies irritating the surface of the eye, and
to destroy granulations of the conjunctiva, which act somewhat as foreign
bodies do. Having everted the lid, then, with the point of a bistoury
you make a very small incision into the cyst, and then perhaps you make
a little cross cut. This is very easily done. You stand behind the
patient, and support his head upon your breast, and then with a small
sharp-pointed probe, slightly bent at the point, you endeavour to tear up
the cyst. You allow the bleeding to stop, turn out the glairy contents,
lacerate the cyst a little, and let the eyelid resume its customary place.
It discharges for a few days, but it then gets well, and usually there is no
return of the disease. Now and then, however, the disease will return ;
and if you have a patient in whom the operation has been ineffectually
performed previously, or in whom the disease has reappeared in spite of
its due performance, though it very seldom does, you may be under the
necessity of taking still more certain and effectual measures. You open
the cyst, allow the contents to escape entirely, and stay till the bleeding
has ceased ; it will do so all the sooner that the lid is permitted to resume
its normal position. You may then dip the end of a small probe slightly in
nitric acid, and put it with much care into the cyst, or with a probe such
as this (presenting it) you may introduce a minute portion of caustic
potass into the cyst, and it is strange indeed if it is not then effectively
destroyed. The surface of the eyeball must be protected against the
potass, but there is no chance of its being injured if you use a portion
only about the size of a pin's-head, and keep the eyelid away from it, or
you may rub the surface of the conjunctival membrane over with olive-oil,
or you may apply a small bit of lint over the opening, previously soaked
2 u
338 AMPUTATION OF THE ANKLE JOINT.
With dflnte Tioegar, or you may leaTe a ihin bit of linty spread with
some bland ointment, between the lid and the ball of the eje for a short
tune. This, howeyer, is scaroely neceaaaiy. By this means yon efi^ctn-
ally and safely remove these encysted tomonn ; they are very troable-
some^ and it is wdl that yon should know how to treat them propeily."
On Amputation of the Anlde Joint,
In the last number of the London and Edinboigh Monthly Joornal
of Medical Science Mr Syme gives several cases of ampatation of the
ankle joint as recently introduced by him. This amputation at the ankle
joint is not a new one, having been performed at different times by several
suigeons on the Continent ; but in all probability the result in these cases
had not been very satisfactory, as the opoation had never been adopted by
others^ and we can scarcely wonder at this when we consider the mode in
which it was performed. Under these dicumstsnces^ we are of opinion
that fully as much merit attaches to the re-introduction and the establish-
ing upon a proper basis an operation which had &llen into disrepute, as to
its original proposal. We r^ard the introduction of this amputation as a
very great addition to surgery, inasmuch as it supplants a dangerous
operation by one attended with comparatively littie risk, and at the same
time yielding in every point of view a much better result. We agree
completely with Mr Syme when he saya^ *^ It may seem a startling but it
is neverthelefls a true statement, that amputation at the ankle joint, with
hardly any exceptions, may and ought to supersede amputation of the leg
below the knee.
** The advantages of amputation at the ankle joint (says Mr S.), as
compared with amputation of the leg, are not limited to tiie smaller d^;iee
of mutilation and greater utility of the limb ; smce the operation is also
attended with much less danger. This will appear when it is considered,—
1st, How much less the shock must be, from the small extent of parts
removed, which is littie more than in Choparfs partial section of the
foot. 2d, That the smallness of the arteries divided prevents any risk of
serious hemorrhage. 3d, That the cancellated texture of the bone is not
liable to exfoliate. 4Ui, That from the medullary canal remaining ealdre,
inflammation of its contents, and also of the veins^ is preventied.''
This statement is, we think, fully borne out by experience. Mr S. refers
to fourteen cases where the operation has been performed ; eight in his own
practice, and six in that of others, without a fiital result. We have our<
selves seen most of the cases in which the operation has been p^ormed
by Mr Syme as well as by his collei^es in the Infirmary of Edinbai^h,
and we were much gratified by the progress of the cases, by the com*
paratively littie constitutional disturbance which followed the operation,
as well as by the exceUence of the results, even in those in which, from
the state of the soft parts, reasonable doubts as to its success might ha?e
been entertained. We may here remark, that however much tumefiiction
of the soft parts may exist, it need form no bar to the performance of the
operation, inasmuch as we find that here, as after excidon of the elbow
joint, the soft parts rapidly return to a healthy condition when the diseased
bone is removed.
In one of the cases operated on in the Royal Infirmary, in which the
disease of the soft parts existed to an enormous extent, this was parti-
cularly striking; the tumefiiction diminishing after the operation with
AMPUTATION OF THB ANKLE JOINT. 339
great rapidity, and union taking place in almost as short a time as if the
integuments had heen in a perfectly sound state.
The peculiarity of Mr S.'s operation consists m the saving a flap from the
sole of the foot and thick integuments of the heel, by making a transverse
incision, and dissecting these parts from the os calcis, so that the dense
textui'es provided by nature for supporting the weight of the body might
be still emplo^'ed for the same purpose.
The mode of peiibrming the operation we give in Mr Syme's own words :
— -'' The best instrument for performing the operation is a large bistoury,
or small amputating knife with a blade about four iaches long. There is
no occasion for a tourniquet, as the assistant has complete command of the
vessels by grasping the ankle. In my first operations, the flap was made
unnecessarily long ; and I feel confident that the following directions may
be trusted for exactly determining its proper extent. The incisions across
the instep and sole of the foot should be curved, with the convexity for-
wards, and exactly opposite each other. A line drawn round the foot mid-
way between the head of the fifth metatarsal bone and the malleolus
extemus will show their extent anteriorly, and they should meet a little
way farther back, opposite the malleolar projections of the tibia and fibula.
Care should be taken to avoid cutting the posterior tibial artery before it
divides into the plantar branches, as in two cases where I did so there was
partial sloughing of the flap. If the ankle joint is sound, the malleolar
processes should be removed by cutting-pliers ; but if the articulating sur-
faces of the tibia and fibula be diseased, a thin slice of these bones should be
sawn ofif. The edges of the wound should be stitched togethei", and lightly
dressed."
There is one point upon which Mr S. dwells particularly, and that is the
avoiding the cutting of the posterior tibial artery befoi'e it divides into the
plantar branches, a precaution which, if we may judge from the two cases
which he relates, it is very necessary to attend to. In both of these the vessel
had been cut before its division, in one accidentally, in the other intentionally,
from the facility which he had experienced in tying the vessel in the first. In
these cases sloughing of the flap to a very considerable extent followed, in both
through fully half its extent. In the first case Mr S. attributed this to the
undue pressure of a bandage ; but after the second, in which great attention
had been paid to the dressing, he was led to refer it to what we believe to be its
real cause. ^ As on both occasions," he says, " the artery had been cut before
its division, while in all the other cases it had been left entire, and as the
flap at best, being deprived of nourishment from most of its ordinary
sources, could be chiefly supplied with blood only through the successive
anastomoses of small vessels, I concluded that this deviation from usual
practice had led to the mischief in question, and resolved to avoid it for the
future." We would repeat in conclusion, that the profession and public are
much indebted to Mr Syme for introducing this operation, which we
believe is destined in a great measure to supplant the amputation of the leg
below the knee. We may add, that the boot required after the amputation
is very simple, and cannot, we should think, much exceed in price an
ordinary laced one.
Since writing the above, we find that a somewhat similar idea as to the
mode in which amputation at the ankle joint ought to be performed has
occurred to M. Msjgaine, as described in his Medecine Operatairey p. 852.
We give the passage in his own words : — " Le moignon devant reposer sur un
pied artificiel, il importe que la cicatrice ne soit pas au centre. Nous
340 WALNUT LEAVES IN SCBOFULOUS DISEASE.
ferions done un ires court lambeau en avant, par une incision demi-
circulaire aboutissant an boid posterieur de chaqne malleole. Puis
Tarticulation serait attaquee par le cote interne dont la malleole descend
moins de quatre lignes que Tautre, et la desarticulation achevee, on
taillerait le lambeau aux depens de la peau du talon, plus propre que tout
autre, apres la guerison, a soutenir le poids du corps. £t si les malleoles
faisaient trop obstacle a la reunion, nous ne verrions aucun inconvenient a
les retraucher et a obtenir ainsi le moignon le mieux conforme et le
mieux revetu, de tons ceux qui r^sultent d'amputations faites k la jambe
et a la cuisse." M. Malgaine, however, never so £Eir as we can learn per-
formed the operation, although his opportunities for doing so must have
been pretty frequent, having probably the same doubts of its success which
other surgeons entertained.
MATERIA MEDICA AND DIETETICS.
Walnut Leave* in several Varieties of Scrofulous Disease.
Dr Neorier, Professor in the Medical School of Angers, published some
time ago {Gaz, Med, de Paris, 1841, p. 605) a series of cases of scrofula
successfully treated with preparations of walnut leaves. In one of the
numbers of the same journal for June of this year (No. xxiii. p. 853), he
has given a second series of affections of the same kind, in which he has
found the same remedy as successful as in his former trials. The cases re-
ported in both series are reducible to, — Isi, Unulcerated scrofulous swell-
ings ; 2dy Scrofulous ophthalmias ; Sd, Scrofulous swellings in a state of
ulceration ; 4ih, Scrofulous swelling and caries of bones. During the three
years that have elapsed since his first memoir was published, he has c<»i-
tinued to employ the same treatment in such cases, and has obtained, as he
says, satisfactory evidence of its permanence.
We cannot say we should have much faith in such a remedy without
very numerous trials, yet it must be confessed that all parts of the wahiiit-
tree have powerful sensible qualities ; and the fruit, the oil of the fruit, the
membrane which invests the kernel, the inner bark of the tree, and even
the leaves, have been before known in medicine. Besides the tonic, anti-
spasmodic, and vermifuge virtues ascribed to some of the other parts, an in-
fusion of the leaves has been popular in jaundice and in the cutaneous
eruptions of children ; the leaves, moreover, are said to cure itch on being
rubbed on the affected part, and when madein to a pomatum with lard, to
favour the growth of the hair.
Treatment of Gout and Rheumatism,
In the Journal de Pharmade for July 1844, we find the two following
methods of treating gout, the one English, the other French, placed in one
rticle : —
In gout and rheumatism, Dr Wells, it appears, recommends the affected
part to be rubbed with dry flannel for twenty minutes, and afterwards to
be covered for three hours with some compresses, kept moist with ^ £au
de Cologne." This topical treatment, kept up for two or three days, cures
both gout and rheumatism.
The French plan is that of Dr Henrotay of Anvers, and consists in the
use of colchicum for one or two days, followed by pills of golden sulphuret
VARIATIONS IN THE WEIGHT OF PRISONERS. 341
•mony, with a small proportion of opium ; one to be taken night and
' for fifteen days.
:ixturey reduced as nearly as possible to the form used in this
, is as follows : —
R Pulv. gummi acac. Arab., . . . §ii.
Aquie purs, ^viiu
Alcoholis colchici, . . • • . 3ii*
Syrup rhei, gii.
M. et 8. a. fiat mistura cujus sumat cochleare magnum omni altera hora.
The pills, which are to be begun the next day, are the following : —
1^ Sulphur, antimon. aurat., . . .Si.
Opii pun, . . . . ^ gr. iv.
Pulv. rad. glycyrrhizfle, . . . 3i.
Mucilag. acac. Arab., . • . q. s.
Confice in mass, divid. in pill. xxx. squales.
All spirituous and fermented liquors are to be avoided, and nothing but the
lightest food taken.
Notice on the Variations in the Weight of Prisoners subjected to the Regimen
of a Penitentiary. By Dr Marc D'Epine of Geneva. From the " Annales
d'Hygiene Publique, Juillet 1844, 63 no."
The paper whose title is quoted above is too long to translate. We pro-
pose to extract some of the facts contained in it, and to interpose one or
two observations on the subject. Dr Marc D'Epine, as physician to the
prisons and member of the Council of Health in the Canton of Geneva, has
had favourable opportunities for the task which he has undertaken. His
object in registering the weight of the prisoners was to ascertain the effects
produced on the process of nutrition by confinement. The greatest precau-
tions appear to have been taken to avoid all possible sources of fallacy.
The facts reported are deduced from a register kept for four years, namely,
from 1838 to 1842.
The penitentiary of Geneva, from which alone the report is drawn, con-
tains no prisoners sentenced to less than a year's confinement. The
inmates are all males, and amount on an average to sixty. They are for
the most part young adults ; but a small proportion exceed forty years of
age, the great majority being between twenty and forty, or rather between
twenty and thirty. There are a few, though the proportion is much
smaller, between twelve and twenty. The discipline is that of Auburn,
with some exceptions ; labour in public with strict silence during the day,
and at night solitary confinement in cells. The prisoners are, however, ar-
ranged in four divisions : Isty Those treated with the greatest severity are
those condemned to a long term of imprisonment, and those who have been
convicted more than once ; 2^, Those whose offences are less in degree ;
t^y Those whose punishment is purely correctional ; Ath, A few whose
punishment is correctional, the very young, and those who have behaved
well. Even the worst of the criminals confined maj' by good conduct
pass from the first division to the last, in which the treatment is mildest.
The differences in the degree of severity lie in the liberty to obtain addi-
tional comforts with the money gained by their labour, in the degree of
liberty at the time of airing, in the meals being taken in common and not
in soUtary cells, lastly, in the use of a flower-garden allowed only to the
very young, and to those who have shown signs of amendment.
342 VARIATIONS IN THE WEIGHT OF PRISONERS.
The aliment of all the prisoners consists of twenty>one ounces of bread
dailj, sonp morning and evening, poise at noon, potatoes at discretioii.
** La soupe est an beurre, aux legames, an riss, on an gros ble, cinq fois par
semalne ; elle est an bouillon de viande mel^ aux m^mes sobstances all-
mentaires le lundi et le vendredi, et on donne demi livre de yiande a chaque
prisonnier le jeudi et le dimanche. La boisson est l*ean pure rendue,
pendant les chalenrs seulement, legerement amere avec de la racine de
gentiane. Le vin et le tabac sont interdits." The prisoners work chiefly
in sedentary occupations for ten or eleven hoars, three hours are consumed
in meals and repose, the rest of their time in sleep.
The prisoners were weighed at their reception, and once every six
months. Those below twenty-two years of age are excluded in most of the
following averages. The average loss of weight was not found to be very
great, but strikingly increases with the severity of the treatment, or it is
considerable only in the prisoners belonging to the two first divisions.
The comparison between the first and last weighing in 186 prisoneis
shows a loss of weight in eighty-eight, a gain in eighty-six, and no change
in twelve ; but this estimate includes those under twenty-two years of age.
When these are excluded, out of 134, seventy-four had lost weight, forty-
eight had gained, and twelve remained unchanged. Out of eighty-seven
belonging to the two divisions in which there was greater rigour of confine-
ment, fifty-three had lost weight, thirty had gained, and four remained
unchanged. Out of forty-seven in the quarters, where less rigour ivas
exercised, twenty-one lost weight, eighteen gained, and eight remained
unchanged. Or for ten who gained in the severe quarter, fourteen lost ;
for ten who gained in the less severe quarter, eleven lost ; and the proportion
of those who retained their weight unchanged in the less severe quarters is
nearly quadruple as compared with those of unchanged weight where
greater rigour was exercised.
Season appears to have nuide little or no difference on the results, though
the weighing took place in the opposite months of January and July.
Our author has contrasted his own results with those drawn irom an
English prison, namely that of Devizes. The facts referred to are drawn
from the Second Report of the Inspectors of the Prisons of England. In this
prison, out of fifty-one prisoners, whose weight each was less than 100 lbs.,
or who as it is to be presumed had not reached adult age, forty-five in-
creased, four lost weight, and two remained unchanged. Out of 449 adults,
274 gained weight, 136 lost weight, and thirty-nine were stationary.
The discipline in the prison of Devizes is described as solitary confinement
by night, silence by day, active emplo3rment, as the treadmill and working
of pumps, few sedentary occupations ; aliment entirely vegetable ; punish-
ments a combination of moral and corporal.
The difference in the results obtained in the English prison is quite re-
markable. Instead of eleven losing weight for every ten that gained under
the mOder discipline, and fourteen losing weight for every ten that gained
under the severer, as in the Geneva Penitentiary, we find in the prison of
Devizes ten gaining weight for every five that lost ; and this, it is to be
remembered, under a diet strictly vegetable, while at Geneva, a pound of
solid animal food was allowed weekly to each prisoner, besides meat soup
twice a- week.
Two very important circumstances must be taken into account, which
show the necessity in all statistical reports of suppressing no part of the
particulars. In the English prison, the average period of confinement does
not appear to have exceeded three months, while no prisoner was sent to
VEGETABLE DIET. 343
the penitentiary at Geneva for less than a year. This difference in the
period of confinement probably affords an explanation of the difference in
the results. Something may also depend on the greater vigour of digestion
produced by the more active exertions in the English prison.
We have brought this subject before our readers, believing that such in-
quiries are of the greatest possible importance. We admit that much
difficulty attends them, and that much error arises from imperfect accounts ^
being received as just data ; but that source of fallacy can only be corrected
by ^e multiplication of observers, so that the truth may at last prepon-
derate over the errors which in our first attempts at statistics are unavoid-
able in every department. It is surprising how little has hitherto been
done on this plan in the department of dietetics. We only begin to know
the approximation to the range within which the amount of aliment neces-
sary for health lies, from which the important fact appears, that in given
circumstances the difference between too much food and too little lies be-
tween very narrow limits.
Letter from an Octogenarian Surgeon to Mr Wakleyy M, P., showing that he
has lived in health for forty years on a strictly vegetable diety and brought
up a healthy family on the same diet.
Sir, — In the Times newspaper of the 4th instant, you are reported to
have said, ** That you had found, to your surprise, that for the first fort-
night of an untried prisoner's incarceration he was subjected to the lowest
possible diet, being denied, in fact, all animal food fur the first fourteen
days of his confinement ;" you obviously would represent this restriction
from animal food as a most inhuman and injurious treatment.
I apprehend it to be impossible for you not to know that the experience
of all ages has proved, that the healthy man can be perfectly nourished
without using a particle of animal food. I will fearlessly assert, from long
experience, that vegetable food is much more salubrious than mixed diet in
common use, in which, however, animal matter commonly enters in the
smallest proportion. Numerous instances may be cited of persons who
have lived for years in veiy good health without animal food ; but I will
here content myself with very shortly informing you of my personal expe-
rience in this matter.
In the year 1804 (in January) I resolved to confine myself to a strict
vegetable diet ; I was induced to this by severe bodily suffering. In this
course I have persevered, without deviation, to the present time, now more
than thirty-eight years, and by its means have now advanced considerably
in my eightieth year. The diet has been aided by other measures, which I
need not enter into. I have brought up a large &mily on the same plan
with perfect success. My eldest son, who was in childhood very delicate,
with an obvious consumptive tendency, has used the same regimen for an
equal length of time, and is in perfect health ; and I could cite numerous
instances of its beneficial effecta in various individuals.
I am no advocate for starvation, and opposed, certainly, to a mere bread
and water diet. Indeed, I cannot approve of any fixed dietary, it being
abhorrent to nature, which delights in variety, — ^the vegetable kingdom
affords variety sufficient to satisfy any hedlthy appetite.
I have addressed to you these facts, as, in the station you hold as a mem-
ber of Parliament, what falls from you on medical subjects may have con-
siderable influence either for good or for evil ; and I shall be sorry to see
344 ALKALINE TREATMENT OF TUBERCULOUS CONSUMPTION.
talents of no mean order employed to fortify vulgar prejudicesy or dissemi-
nate erroneous opinions. I am^ Sir, your obedient servant, i
Wm. LAMBE, M.D. I
BramptoUy July 6, 1844.
PATHOLOGY AND PRACTICE OF MEDICINE.
^ Alkaline Treatment of Tuberculous Cfonsumption, — J. S. Campbell, Pascal,
Louis.
Two or three years ago Dr J. S. Campbell published a book on Tuber-
culous Consumption, in which he advocated the utility of alkaline treat-
ment, and reported some cases in which he believed the disease had been
stopped in its progress by this mode of treatment. In a recent number
of l^e Lancet (Saturday, 10th August 1844) he has inserted a paper on
the same subject, in which he answers some of the objections made to his
views, states the result of his former cases, and refers to numerous other
cases in which, as he thinks, the same treatment was effectual. Dr
Campbell appears to be well aware that on such a subject incredulity is
justly regarded among his brethren as a virtue. He has accordingly
taken some pains, by reference to auscultation and percussion, to convince
us that the cases treated, or at least the major part of them, were really
cases of progressive tuberculous phthisis, of which hereafter.
We cannot take time at present to inquire how £ar this kind of treat-
ment has been practised in past times. We admit, however, that the
treatment of phthisis by alkidies forms no part of the established stock
of a medical man's knowledge. Dr Campbell's remedy is the solution of
caustic potass, and therefore does differ, though but slightly, from that
mentioned in the passage we are about to quote.
We find the following passage in the last edition of M. Louis' work on
phthisis — ^we quote the Sydenham Society's translation. *^ Very re-
cently, and about the saipe time (about 1835) that M. Latour believed
himself called upon to counsel the use of sea-salt in the treatment of
phthisis, M. Pasod of Strasburg recommended the sub-carbonate of potass
against the disease. M. Pascal founded his recommendation, d prioriy on
the discutient property of the alkaline salts, and more especially of the
sub-carbonate of potass, in engorgements of various kinds. M. Pascal
compasses the cure of phthisis by dissolving the albumen, which he says
forms the greater part of tumours and engorgements of all descriptions ;
while M. Latour fancies he has arrived at the same result by means of
searsalt, not through any solvent property possessed by it (for of this he
makes no mention), but through its special tonic properties, seconding the
action of a succulent and tonic regimen.
^ But if the cases of M. Latour leave much to be wished for, on account
of the poverty of the details accompanying them, those of M. Pascal are
so deficient in this respect, that it is redly impossible to determine under
what affections his patients laboured. I have considered myself for this
reason absolved, at least for the present, from the duty of trying sub-carbonate
of potass." P. 615.
We have no purpose of extending the censure passed by M. Louis on
M. Pascal to Dr Campbell. Yet Dr Campbell must excuse us if we pro-
nounce the evidence produced in &vour of this treatment still unsatisfactoiy.
The cases in his book are too few, and the account of his subsequent cases
in his late paper too vague, to bring conviction on a subject which requires
ALKALINE TREATMENT OF TUBERCULOUS CONSUMPTION. 345
eyidence only short of that admissible in favour of a remedy claiming to
cure scirrhus or medullary sarcoma.
For the present, then, we can only speculate on the A priori merits of
the treatment, or consider whether or not Dr C/s statements warrant us to
make a trial of it. Against the trial of alkaline treatment in any disease
in which no established successful treatment exists, no considerable ob-
jection can be urged. Though potass hardly enters into the constitution
of the fluids or solids of the living frame, it cannot be regarded as foreign
to the system in the sense of a noxious agent. With all vegetable aliment
much potass enters the system, and since it is little required as a consti-
tuent, it must be continually thrown oflF by excretion, — as it would seem,
chiefly by the kidn^. The physiological effects of alkalies, and of potass
in particular, have been unaccountably neglected ; — they are beneficial in
several diseases without any satisfactory reason being assignable. Potass
is plainly not merely a local remedy, or a remedy on the urinary function
alone, as in its antacid and antilithic operation ; it is undoubtedly a con-
stitutional remedy ; witness its efiPects on some of the most obstinate forms
of chronic cutaneous diseases. On the whole, then, we think it would be
unreasonable scepticism to refuse altogether to give Dr C.'s remedy the
benefit of a trial ; nor do we believe that any inconvenience will result,
in most 'cases of phthisis, so long as it does not derange the urinary
function. We would caution our sanguine readei-s against indulging too
readily in the idea entertained by Pascal that potass is a solvent of the
constituent albumen of tubercle.
If a trial is to be made of alkaline treatment,, we certainly think that
Dr C.'s remedy should be preferred ; for, though many eminent authorities
maintain that the liquor potasaie cannot have any other final efiect on the
body than the carbonate into which it must pass, we nevertheless con-
ceive, that in makin^g trials declared to be warranted by experience, the
original directions as fiir as practicable should be followed. Twenty drops
of the liquor potasse three times a-day, cautiously increased, will make a
proper trial.
New Method of Detecting Sugar in Diabetic Urine. By Dr Capezzuoli.
Some grains of the hydrated oxide of copper are to be mixed with as much
solution of caustic potass as to retain a sensible alkaline quality in the
liquid. This is added to the suspected urine at a common temperature.
The urine becomes turbid, but a copious pi*ecipitate soon falls down. The
precipitate is at first of a i^y-blue colour, then, after a few hours, a circle
of canary yellow forms at the surface of the mass, and usually covers it
entirely. Afterwards a red colour more or less deep, in the form of a zone,
is substituted for the yellow either wholly or in part. These changes are
completed within twenty-four hours, and depend on the reaction of the
sugar on the oxide of copper. The oxide is by degrees despoiled of ita
oxygen, and brought to the metallic state. The sugar, by the absorption
of oxygen, is transformed chiefly into formic acid, which combines with the
potass. The reaction is strong with the sugar of gmpeB, of which diabetic
sugar is a form. The yellow zone, succeeded by the red zone, is a genuine
sign of the presence of sugar in diabetic urine, for these changes are not
produced in the healthy state, nor in any other disease of the nrine^-*-
Abridged from the author's accounts — See Gazette Toecane, 1843, Beo*
Mid^ and Journal de Pharmacie, Juillet lB4tL
2x
346 COMPOSITION OF CHLOROTIO BLOOD AND URINE.
Composition of Chhrotic Blood and UrinCy and Effect of Ferruginotu
Preparations, By M. Herberoeb.
{Burner's Bepertorium^ yoI. zxix. 1843, p. 236.)
The blood of a girl twenty years of age, who was chlorotic in the highest de-
gree, hut was otherwise robust, yielded a tolerably firm clot, but no traces of
inflammatory crust. This blood was composed of 868 parts of water and
131 parts of solid matter in 1000. After two months* use of ferruginous
preparations, the same girl's blood yielded 807 parts of water and 192 parts
of solid matter in 1000. The solid matter in the two specimens of blood
yielded respectively in 1000 parts —
Chlorotic blood. Blood after core.
Fibrme, . . 3.609 . . . 1.950
Globuline, . . 36.470 . . 94.290
Albumen, . . 75.200 . . . 81.509
Hematosin, • . 1.590' . . 4.029
Fatty matter, . 2.310 . . . 2.470
Extiactiye and salts, 8.921 . . 8.263
Loss, . . 0.500 . . . 0.409
The urine was examined three times on different days before she was put
on the use of ferruginous preparations, and twice after the cure, with the
following results :
1000 parts of urine during disease yielded
(1)
(2^
(3)
Water, .... 975.43
978.21
971.98
SoUd matters, . . . 24.57
21.79
28.02
The solid matters were composed of
Urea, .... 7.04
7.00
7.12
Uric acid, .... 0.13
0.21
0.19
Extractive matter, . . 10.48
9.00
13.99
Salts, 6.80
5.50
6 62
Loss, .... 0.12
0.08
0.10
1000 parts of urine after cure yielded
#i\
/o\
Water, .... 94oVl6
938.70
SoUd Matter, ....
59.84
61.30
The solids were composed of
Urea,
26.84
27.36
Uric acid, ....
0.94
0.96
Extractive matter, .
18.62
16.28
Salts,
13.32
15.71
Loss,
0.12
0.99
During the treatment M. Herberger states that, contrary to the assertions
of Grelis and Wohler, the urine distinctly contained iron, which was very per-
ceptible in that passed in the morning ; he also states that the iron was con-
tained in the sweat.
Cryptogamic Vegetations in the Stomach*
M. Grubt communicated the case of a female in whose stomach cryptoga-
mic vegetations were spontaneously formed. She had been subject to vo-
miting for four years, and it was in the matters vomited that he had found
.these formations ; after fasting twelve hours she still vomited cryptogami.
On introducing, a piece of sponge by means of a sound, he was enabled to
DIARRHCEA IN CHILDREN. 347
withdraw them from the stomach. The sponge also hrought them up from
the inferior portion of the oesophagus, hut not from the superior. No traces
of the cryptogami were found in the alimentary suhstances ingested, which
were carefully examined. Their production seems to diminish under the
influence of sJkaline drinks and of hrandy, and to increase under that of a
vegetahle alimentation. A purely animal regimen does not, however, appear
to weaken it.*
MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN.
. On the Use of Tincture of Opium in the Scrofulous Ophthalmia of Children.
^ Among the very numerous suhstances which have heen recommended as
useful and curative in scrofulous ophthalmia, I may mention tincture of
opium ; it is used either diffused in water as a lotion, or mixed with lard as
an ointment, and is seldom used pure. Lately, however, Kopp has recom-
mended in this disease compresses to he dipped in the undiluted tmcture
and laid on the eye, together with the internal administration of the extract
of conium maculatum. I have latterly treated all my cases in this way,
and have invariably been surprised at the successful results ; and never has
this method of treatment failed, whether the inflammation was accompanied
simply with intolerance of light without redness, or with both redness and
epiphora. The amendment of the disease generally appears in a few days
after the use of the compresses, and in many cases it was so exceedingly rapid
that I ascribed it to the influence of the conium ; but in one instance which
had resisted all other means, and where the child could not be got to take
the extract, the disease was cured by means of the compresses alone. Since
then I have used the tincture of opium with the most marked benefit, more
especially in the torpid form of ophthalmia. As an alterative for internal
administration, I prefer before all other means the extract of conium ma-
culatum accordmg to the formula of Dzondi and Kopp.'' — Dr Bennewitz in
the Journal filr Kinderkanky Bd. I. Hft. 3.
Diarrhoea in Children treated with Injections of Nitrate of Silver.
" In many children that died under excessive vomiting and diarrhoea, I
found the large intestine red, swollen, softened, and ulcerated ; and from
these appearances concluded that, to cure the disease, the remedies ought to
be locally applied ; and accordingly I prescribed enemata containing nitrate
of silver, and administered the same substance internally. The dose for the
enema was § gr. in giij- of water, and the mixture to be given by the
mouth consisted of
Nit. argent. • » . ^ gr.
Aquffi font. • • • * Si*
Syrup simp. . . . 3x. M.
To be taken in the course of twenty-four hours in doses of a teaspoonful at
a time.
In some cases the diarrhcea obstinately continued, and then I modified
the pirocedure of injection in the following manner : immediately after the
enema of nit. argent, was administered, I gave a second injection of pure
water, so that, without increasing the quantity of the caustic, its action-was
extended further up the intestine." A case is here given of a dropsical and
rachitic child affected with diarrhoea for several months, but after the in-
• See Wilson on the Sarcina Ventriculi, North, Joum. of Med., No. III.
848 ON ENEURESIS NOCTURNA.
jection of | grs. of nit ai^nt. in ^vj. of water, with the supplemental in-
jection of an equal quantity of pure water, the diarrhoea from that time
oeased.
** In violent diarrhoeas my treatment is, to commence with an emetic of
from 26 to 40 grs. of puly, ipecacuan, in syrup, every five or eight minutes.
If the child is still on the hreast, it must luye nothing hut the mother's
milk ; if weaned, it may have milk mixed with harley- water. In addition
to this, I give the enema of nit. argent, as ahove prescrihed, or varied in
strength with the age of the child ; and along with it I adminiBter a mixture
of nit. argent, (vid, 9up,\ nit. hismuth., or chalk combined with extract of
ratany root." — Trou9»eau*9 KUnik Joum, fUr Kinderkanky Bd. I., Hft. 3.
— Since reading tiie above, we have tried the enema and mixture in one or
two instances^ and have found this mode of treatment perfectly successful,
so far as our sphere of observation has extended ; we therefore recommend
it to practitioners for further investigation.
On Eneuredi Noctuma, or Incontinence qf Urine during Sleep. By Prof.
BOHBERG.
^ Girls suffer from this affection more frequently than boys. It is consid-
ered to depend on paralysis of the neck of the bladder ; and hence the cold
douche, decoction of cinchona, and the preparations of iron, have all been
recommended for its cure, but without benefit, for the source of the affection
is quite different. In the healthy state of the mucous membrane of the
bladder, two points appear to possess greater sensibility than the rest, —
these are the openings of the ureters. We know this, because when, in
making an examination of the bladder with the sound, we touch these
points, an excessive desire to make urine is felt. If, then, the mucous mem-
brane of the bladder is diseased, the irritation of the urine will be most
keenly felt on those parts which are more sensitive than the rest, and this
irritation will act through rapid reflection on the mttsc. deirus. tirtn., and the
more easily during sleep, as in that state the power of the will over the re-
flex functions is inactive. On these grounds, then, I recommend you, m
such cases, to cause the children to be made to lie on the belly, so as to
protect these points of the bladder as long as possible from the irritation of
the urine, and to diminisli this property of the fluid, mucilsginous drinks
are to be allowed."
We have never failed to remedy incontinence of urine in children by
constitutional tonic treatment, conjoined with an occasional blister on the
sacrum ; and when these were tedious in their operation, nux vomica in
powder, or in the form of extract in minute doses, has been highly success-
ful. The treatment recommended by Bomberg, founded on his ingenious
hypothesis, may be useful as an adjunct, but cannot supersede the other
means.
FOBENSIC MEDICINE AND MEDICAL POLICE.
Statistics of the Transmission of Insanity. By M, Baillaroer,
M. B. proposes to determine the three following questions : —
1. Is hereditaiy insanity more commonly derived from the mother than
from the father \ 2. Is the disease of the mother communicated to a greater
number of children than is the disease of the fi&ther ! 3. Is insanity more
commonly transmitted to daughters from the mother and to sons from the
father!
STATISTICS OF THE TRANSMISSION OF INSANITY. 349
First question, — ^In 453 cases of dlrecUy tranamitted hereditary insanityy
the disease was derived
From the mother, . . 271.
father, . . . 182.
The difference is 89, or }.
Second question. — In 271 families in which insanity was derived from the
mother, the disease, at the period when inquiries were made, had appeared
In 208 fjEimilies in 1 child in each.
... 62 ... 2 children.
••• o ... o «..
... 1 ... 4
Total number of insane children, 846.
The madness of the mother, then, was transmitted to several children 70
tiroes out of 271 — that is to £ay, in upwards of one-fourth of the cases.
With respect to madness derived &om the father, M. B. found, that in 182
families in which the disease had this origin, the malady, at the time the
inquiries were made, had affected,
In 152 £Eunilies, 1 child in each.
... 26 ... 2 children.
... 4 ... 3
Total number of insane children, 216.
The madness of the father had then been transmitted to several children, in
80 out of 182 instances — t. e, in one-sixth of the cases. Consequently the
madnesB of the mother, while it is more frequently hereditary than that of
the father, seems also more prone to attack a greater number of children.
Third question, — ^Among 346 children who inherited insanity from the
mother, there were 197 daughters and 149 boys ; the difierence is 48, or
one-fourth. Among 215 children who inherited insanity from the father,
there were 128 sons and 87 daughters ; the difference is 41, or one-third.
Madness of the mother, therefore, is more frequently transmitted to the
daughters than to the sons, in the proportion of one-fourth ; while the
madness of the father, on the contrary, aflfects the sons more frequently
than the daughters, in the proportion of one-third. On comparing these
results, two other interesting inferences may be deduced from them. We
find, in fact, that of 277 sons, 169 derived the disease from their mother,
128 from the father ; the difference is scarcely one-sixth. In the daughters,
on the contrary, this difference is much greater ; and this seems a more in-
teresting result than any of the foregoing ones. Of 274 insane daughters,
189 derived their insanity from the mother, 85 only from the &ther;
the difference is 104, or more than one-half; whence foUows the conclusion,
tliat sons derive insanity almost as frequently from their father as from
their mother ; but that daughters, on the contrary, inherit the disease from
the mother at least twice as frequently as from the father.-— The foregoing
numbers lead to the following results regarding the prognosis we should
give respecting children bom of an insane parent. 1. Madness of the
mother has a more formidable hereditary influence than that of the fi&ther^
not only because it more frequently becomes hereditary, but also because
it is liable to attack a greater number of children. 2. Transmission of
madness from the mother is more to be apprehended for the daughters than
for the sons ; that of the father, on the contrary, is more liable to affect the
sons. 3. Transmission of madness from the mother to the sons is scarcely
more to be apprehended than when the father is affected ; but it is twice as
likely to affect the daughters.— 2>u&itn Med, Press, May 22, No. 281, p. 328.
350 WOUND IN THE THORAX.
DANGEROUS OR FATAL CONSEQUENCES FROM SLIGHT WOUNDS.
As medical witnesses are frequently annoyed in court with questions as to
how slight a wound may be productive of dangerous or fatal consequences,
we extract the two following cases.
Wound in the Thorax from a common Sewing-Needle^
An artillery-man stated, that haying stuck a sewing-needle in the lining of
the left side of his jacket, on his lifting a large body, it had been forced into
the skin. On external examination nothing but a idight red point could be
discovered ; the surgeon made an incision, but finding no trace of the needle
desisted from farther interference. In twenty-four hours thereafter the
man was attacked with fever, violent pain in the breast, and, in short, all
the symptoms of pericarditis, and asserted, that at each heart- stroke he felt
the prick of the needle. Under these circumstances, the regimental surgeon
made a crucial incision at the point indicated by the patient, between the
fifth and sixth ribs, and, after a tedious and careful dissection among the
soft parts and intercostal muscles, the needle was at length felt with the
knife, and easily extracted. The needle was one inch and a quarter in
length, and fine, with the eye directed towards the thoracic cavity, and had
already become rough on its sur&ce. Under the usual antiphlogistic treat-
ment the patient was in four weeks so far recovered as to be able to leave
the hospital. — Medizin Zeit, Jarhg.y XII. No. 30.
Death from the Paring of a Com,
A STOUT and healthy labourer affected with a com on the little toe, cut it
rather deeply, and, in spite of the pain, continued to attend to his work for
several days ; no local alteration could be seen, except ecchymosis and some
slight puffiness of the sole of the foot ; he was soon, however, seized with
extreme difficulty of deglutition and articulation, unusual brilliancy of the
eyes, with full pulse, and died the same evening. On examination after
death, pus was found under the integuments of the foot, and blood in the
bursa mucosa over the joint of the toe. — Caspar's Wochensch., No, 6, 1844.
Part IV.— MEDICAL MEMORANDA.
Evacuation of an Infant's Stomachy in a Case of Poisoning^ by means of a
Male Elastic Catheter adjusted to a Stomach-Pump, — Mode of Decanting
the Stomach by a Flexible Tube without a Stomach-Pump,
In a late number of the Lancet (Saturday, 10th August), Mr D. Thompson
of Stalybridge relates a case in which he succeeded in saving an infant
(st, six months), to whom a teaspoonful of laudanum had been admin-
istered by mistake. Vomiting could not be excited by emetics, and having
no cesophagus tube narrow enough for an infant, he introduced an elastic
gum catheter, the end of which he attached to the stomach-pump, and
withdrew the poison.
Considering how susceptible infants are of the effects of opium, we can-
not doubt that Mr lliompson saved the infant's life in this case by his
ready contrivance.
We take this opportunity of drawing the attention of our readers to the
facility with which the stomach can be emptied and repeatedly washed
EVACUATION OF AN INFANT'S STOMACH. 351
out without a stomach-pump by means of a simple flexible tube. When
the siphon is spoken of for the evacuation of the stomach, one is apt to
think of something very complex and difficult to manage. Yet nothing
can be easier. Mr Bryce's siphon is highly ingenious, but cumbrous and
unnecessary. When the common gullet-tube, such as is sold with the
stomach-pump, has been introduced down to the stomach, all that is
necessary is to pour water into its extremity by means of a lipped vessel ;
and this is for the most part easy, unless the tube be very narrow. As soon
as a sufficient quantity of water has been poured in, the head of the patient is
to be bent down till the mouth falls below the level of the stomach, when the
fluid contents of the organ rush out in a full stream. Thus the process of
washing out the stomach may be repeated many times by this method, for once
that it can be done by means of the stomach-pump. The tube in this case
does not act the part of a siphon — ^it would become a siphon if it were long
enough to reach externally below the pit of the stomach, in which case the
contents of the stomach would continue to be discharged after the head had
been raised to its usual position. The process first described is in fact a
process of decantation, and this appears to us to be the best name for it.
It difibrs in no respect from the decanting of liquor from a bottle, except
that no air enters, the capacity of the stomach itself being diminished as
the fluid issues, because it is subjected to the pressure of the atmosphere
through the yielding parietes of the abdominal cavity.
No doubt the introduction of water into the stomach is troublesome
when the tube is narrow ; but even when this difficulty cannot be over-
come, and the pump is required to throw it in, much time will be saved if
it be drawn off^ again by bending the body down instead of by the slow
action of the pump.
However narrow the tube, if a common funnel be at hand, and the upper
end of the tube be adjusted to its pipe by a bit of wet tow or rag, the
difficulty will be overcome. If the tubular gag of horn usually contained
in the box with the stomach-pump be not required to prevent the patient
fron^ biting the flexible tube, we find it may be easily made to answer the
purpose of a funnel.
Since we oflered some observations on the advantages of this kind of
evacuation over the stomach-pump,* we have had an opportunity of veri-
fying them in a case of poisoning by laudanum. One day last spring, at
the Royal Dispensary, during the visit, a woman in the immediate neigh-
bourhood was reported to have been in an insensible state for several hours.
On reaching the house we found her without any signs of life, except that
the body was still warm. From the account given by the people of the
hquse, it appeared that she had taken laudanum, most probably for the
purpose of destroying herself. The usual means were put in practice, and
among others, a flexible tube was introduced into the stomach. As the
only tube at hand was unusually small, and no proper lipped vessel could
be procured, the water was chiefly thrown into the stomach by the stomach-
pump— but after a proper quantity had been introduced, no sooner was the
syringe removed, and the head bent down, than the water rushed out
rapidly, notwithstanding the narrowness of the tube, bringing with it the
* Observations on a New Form of the Stomach-pump and Enema Syringe,
and on the Use of the CEsophagus-tube instead of the Stomach-pump. By 'William
Seller, M. D., &c. Scottish and North of England Medical Gazette, No. 3
(4th Nov. 1843).
352 NATIONAL BENEVOLENT INSTITUTION.
contents of the stomach, which consisted merely of a turbid fluid. And
this process was repeated several times with the greatest facility. The
case was, however, too far gone for recovery.
National Benevolent In8titution.^M.n Cullen Brown, Daughter of Soks
Bbown, the Author of the once celebrated Brunonian System.
We have received some papers, fix)m which it appears, that the daughter
of the celebrated John Brown, now sixty-nine years of age, is at present
making a seventh application to be placed on the Roll of the National
Benevolent Institution in London — which will entitle her to receive thirty
pounds per annum. This application will be determined in November by
the votes of a host of subscribers, whose names fill a book now before us of
about 300 pages. If any of our readers be subscribers or have friends among
the subscribers, we could not recommend to them a more benevolent object
in connection with the medical profession.
John Brown was undoubtedly a man of genius, and his system cannot
fail to be remembered while the history of medicine lasts. Its popularity
was as extenfflve as it was short lived, and it shared the fate of all systems
of medicine which seek to raise at once, by a single effort, what can only
be attained by the labour of ages. If his system has been applied by some
to purposes too much akin to quackery, John Brown himself was not a
quack ; and the poverty in which he left his family proves that the profit
to which his system might have been turned among credulous people was
no part of his object.
The statement in these papers is as follows : — " Mrs Cullen Brown, aged
sixty-nine, is the only surviving daughter of the celebrated Dr John
Brown of Edinburgh, who died suddenly in the year 1788, leaving a widow
and eight children totally unprovided for. Mrs Cullen Brown has struggled
hard to support herself by teaching and by literary labours, but being now
very feeble and infirm, is no longer capable of such exertions. She has
survived most of her friends, particularly some of the most respectable of
the medical profession, and is reduced to great distress.'*
Proxies will be received by Mr Vickery, 37 Great Marylebone Street.
Mrs Sophia Baillie, of S3 Cavendlsli Square, takes chaige of the balloting
papers in favour of Mrs Brown.
Fever in Irish Farm-houses,
" There is, however, one class of persons — ^the comfortable farmers — ^who,
though constantly recommended for gratuitous relief, generally keep their
fever cases at home. It soon spreads through the family, though all com-
munication is cut off with * the sick-room,' the door being built up with
sods, and a hole made in the back wall, through which the doctor must
scramble in the best way he can upon all-fours into an apartment which is
almost invariably dirty, damp, and dark." — Dublin Med. Press, 281, p. 325.
Report of an Irish Dispensary.
Printed bjr OliYer dc Boyd, Tweeddale Court, Uigh Street, Edinburgh.
THE
NORTHERN
JOURNAL OF MEDICINE.
No. VI.— OCTOBER 1844.
Part I.— ORIGINAL ARTICLES.
On Deafness, caused by Hemorrhage into the Cavity of the
Tympanum, successfully treated by Perforation of the Mem^
brane: with Statistic Observations on the Results of this Opera^
tion generally. By James Mercer, M. D., F, R. C. S. E.,
Lecturer on Anatomy, &c., Edinburgh.
Until the late Sir A. Cooper published his Memoirs in th^
Philosophical Transactions,* the operation of perforation of
the membrana tympani for the rehef of deafness had been
very seldom had recourse to, or if so, it must have been at-
tended with such success as must have precluded it either
from being taken general notice of by surgical writers, or it
had been set altogether aside from the list of remedies that
were usually employed in the treatment of such cases.
From the very successful results, however, that attended its
performance in his hands, and more especially from the state-
ment with which he concludes his second memoir, that, '^ as a
further encouragement, in the operation I have mentioned,
little pain is felt, no dangerous consequences follow, and even if
it is performed unsuccessfully, the patient is left with the same
capacity as before of receiving relief from other remedies," this
operation became for a short period " the mania of the day,"
and was had recourse to promiscuously, in all cases of chronic
deafness, that had withstood even for a short time the appli-
cation of the comparatively simple tneans that were then
employed*
* Philosoph. TranS; 1800-1801.
2y
354 ON DEAFNESS
Sir A. Cooper, however, pointed out particularly two
morbid conditions of tlip accessory organs of hearing, in which
tlie operation should be tried ; viz., " in closure of the Eustachian
tube," and, secondly, " for the removal of blood that had been
extravasated into the cavity of the tympanum ;" and to these
have been added, by Deleau,* Saissy,t and Kramer ,J a " mor-
bidly thickened and cartilaginous condition of the membrana
tympani."
Instances of the first and last of these forms of disease are
by no means uncommon in practice, and indeed, from the obser-
vations of the above-named authors, as well as from those of
Himly,§ Beck,|| and Itard,f they would appear to constitute a
very common complication in many of the diseases of the ear
that give rise to deafness. In many of these instances, also,
the operation of perforation of the membrane has been had
recourse to for their relief; but in the majority of them it has
signally failed : and it is unfortunate that, amongst all the
information that has been brought forth on the subject, nothing
like statistical details of its results have been given.
Tlirough the kindness of many professional friends in this
city and throughout the country, I have had many facihties
afforded me for observing acoustic diseases, and during the last
five years I have performed this operation, both as a palliative
and as a radical means of cure, in twenty-seven different cases.
Out of this number I selected fifteen that were well marked,
and as coming particularly under the above-mentioned condi-
tions of disease ; six of them being instances of chronic morbid
tliickening of the membrana tympani, and nine of insurmount-
able obstruction, by stricture, of the Eustachian tube. In only one
instance out of this number (fifteen) have I met with complete
success, and that in a case of the latter form of disease. In
all these cases a most careful examination and exploration of the
accessory organs of hearing was made, both by the use of the
speculum and artificial illumination, as also by tne repeated ap-
lication of the air douche and the soUd wax and silver bon^e ;
and every case, also, was, as far as possible, selected from being
apparently uncomplicated with any other morbid condition of
the other structures of the tympanum or of the internal ear.
^ Subjoined, I have classified these in a tabular form ; the first
six being cases of morbid thickening of the membrana tympani,
and the remaining nine consisting of those of insuperable obstruc-
tion in the Eustachian tube.
* Memoire sur U Perfimdon.de Im Mem. de Tymp^, p. 29, Paii^ 1822.
<f £.ssai sur les Malad. de rOreine-inteme, pu 70, Paits» 1827-
$ Diseases of the Ear, tnunsUted bj Dr J. R. Boined^ pu 154, IjondoOy I07-
§ Comuient Soc. Rfg, Sdenc Gdtting., tqL ztL p. 117.
Ii Die loankheiten des GefaSraigans, Ueidelbeig, 182?.
% Memoiies de rAcad^mie Rojale de MtTdicmc^ tome t. pL 53a^ Twoom, \9Mi
FROM HEMORRHAGE OF THE TYMPANUM.
355
Tabular View.
IF.
F.
IF.
45
7
H
9
10
11
12
13 1
WM.
Ck>NDITION8 OF —
Membi TjmiNUii. Eustach. Tubes. Auditory Nerve.
4 Both mucli
J thickened and
J insensible on
1^ touch.
rilBoth thickened.
10 / Both nearly
\ cartilaginous.
Both thickened.
r One destroyed.
\ One thickened.
Both thickened.
Both healthy.
SllghUy thickened
Healthy.
Slightiythickened
Healthy.
Slightiythickened
Healthy.
Healthy.
Healthy.
Both pervious ;
no gurgling.
Ditto
Ditto
Ditto
Ditto
Ditto
Both hnpervious
Ditto
Ditto
Ditto
Ditto
Ditto
Ditto
Ditto
Ditto
Dura-
tion.
Perceptive on
contact.
( Hearing dis-
< tance kk and
t 2 inches.
Perceptive on
contact.
r Hearing dis-
< tance 1 andi
L 2i inches.
Perceptive on
contact.
« Ditto
1 inch each. 2 years.
Only on contact. ^3 years.
1 and 2 inches.. „^,
distance. ^*y^'-
Only on contact. '3 years.
< 1 and U inchL ^^^
\ distancl |1 y^-
Only on contact. 7 years.
Only on contact's years.
2 and 2i inches. 2 years.
Only on contact.'3 years.
3 years.
li year.
4 years.
10 years
3 years.
1 year.
Caries of ext.
No. of times
operated on.
Four times.
Repeated ab
scesses of ext.
meat.
Scarlatina.
Caries vrith
polypus of
ext. meat.
Eczema of
meat.
t Inf.of memb
\ tymp.
Scarlatina.
Scarlatina.
Syph. ulcera-
tion of throat.
Measles.
Repeated ca-
tarrh.
Scarlatina.
( Syph. ul-
I x^eration of Twice,
t throat.
Twice.
Twice.
Four times.
Twice.
Twice.
Twice.
Twice.
Thrice.
Thrice.
Twice.
Twice.
Thrice.
No effect.
No effect.
No effect
catarrh.
/Repeated
i.. catarrh.
Thrice.
No
No effect
No effect
No effect.
No effect
No effect
No effect.
No effect
No effect.
No effect.
No effect
Succes^l
If it were legitimate, therefore, to generalize from the above
number of cases, I might conclude, as Itard has done, that
" nothing is more rare than a cure of deafness by perforation of
the membrana tympani/'*
I may also mention, that the successful case above recorded
has still continued so, though more than two years have elapsed
since the operation was performed. The reason why the re-
petition of the operation was three times required was caused by
subsequent rapid regeneration of that part of the membrane
that was removed, and the consequent closure of the artificial
aperture. At each perforation the success was complete, but
it was not until the third attempt that I did succeed in pre-
venting closure. Having examined this patient lately, I find
that they still continue open, and with a permanent prospect of
remaining so ; and the hearing in both ears is as perfect as ever.
The second condition alluded to by Sir A. Cooper as requiring
the operation, viz. " for the removal of extravasated or accumulated
blood in the cavity of the tympanuuL," appears to have consti-
tuted a very rare practical occurrence ; for, with the exception
• Itard, loc cit. et Rechcrches Pratiques sur les Malad. de rOreiUe, p. 44,
Paris, 1838; and also Cycloped. of Pract. Surgery, article Ear and Hearing,
Diseases of, by T. Wharton Jones, F. R.S.
356 ON DEAFNESS
of the successful case which he narrates, I am not aware at pre-
sent of another having been presented to the notice of the profession.
I have lately, however, met with another and somewhat simi-
lar case, and in which success also attended its treatment by per-
foration of the membrane ; but as there appears to be a difference
as to their proximate pathological causes, I shall, before entering
into the details of this case, refer more particularly to that of Sir
Astley.
" Mr Brandon of Upper Clapton," says he, " sent a person
to me in January last (1801), who had received a blow upon his
head, which had caused symptoms of concussion of the brain, and
was attended with a discharge of blood from each ear. From
the effects which the blow had occasioned on the brain he speedily
recovered, but the deafness which had immediately followed jfrom
the accident continued. I cleared the meatus from the blood
which it contained without any reUef being derived to the pa-
tient ; and, suspecting that a quantity of blood was lodged in the
tympanum, and the vibration of the membrane thus prevented,
I some days after punctured the membrana tympani. Upon
withdrawing the instrument, some dark-coloured blood appeared
on its point ; and, whenever I examined his ear afterwards, there
was the sam^ appearance of blood mixed with the wax of the
ear, which continued to discharge for about ten days after the
operation, during which period the hearing was gradually re-
stored.
" I have formerly known instances of permanent deafness from
this cause ; and I think it not improbable that the blood thus
effused has become organized, and continued to fill the cavity of
the tympanum."*
From the narration of the above case, it must be inferred that,
from a blow having been received, and blood having been dis-
charged immediately thereafter from each ear, together with its
subsequent discharge in a fluid form for ten days after the per-
foration of the membrane, the deafness was consequent on these,
and symptomatic of a counter fissure of the petrous portions of the
temporal bones, involving the thin osseous plates that form the
roof of the meatus and the tympanic cavity.
This opinion, however, is merely an inference drawn from the
statement of the extrinsic symptoms of the case, as made by Sir
Astley ; and as the mode of examination at that period was very
defective, no notice has been taken by him as to the actual con-
dition of the structure of the organs. If counter fissure did
exist, it must have extended across the entire base of the cra-
nium, involving the sphenoid and both temporal bones, as well as
the soft structures of the external and middle ears ; and if such
a condition did not exist, the hemorrhage must have been de-
• PhUos. Trans., 1801, page 444.
FROM HEMORRHAGE OF THE TYMPANUM. 357
rived from the capillary yessels of the j^arts. That such a form
of local hemorrhage does occur as an idiopathic form, the case
that I lately ohserved will evidently show.
Frier, aet. 19, by trade a butcher, and of a stout plethoric
habit of body, applied to me on 2d July last for the relief of " a
spitting of blood and a deafness." On questioning him as to the
causes of these complaints, I found that, for six years previously,
be had laboured under considerable deafness, especially in the
right ear, which he said was almost useless to him, and conse-
quently he had depended for some considerable time on the re-
maining integrity of the left. Having had occasion, about three
weeks previous to application, to proceed to a country market to
bring home some cattle, he was much exposed to cold, moisture,
and fatigue, which were followed by a catarrhal affection that
lasted for ten days, and accompanied with total deafness. About
a week previous to my seeing him, the catarrhal symptoms had
subsided, and the left ear had again recovered its usual power of
hearing, though the right had not.
On awakemng the morning previous to his visit, he felt as if
a quantity of sahva had collected in his mouth during the night,
and, on spitting it on the floor, found it to consist chiefly of
coagulated blood. This was repeated four or five times, and
with nearly the same effect ; but he did not, at any of these
times, either cough or vomit, and he felt distinctly as if the
blood had come from the back part of his mouth. On removing
a dossil of wool, which he had oeen in the habit of keeping in
either ear, he found that which had been over night in the left
to be sUghtly besmeared with blood, at the same time that the
tube itself felt as if contracted and very dry. He also found him-
self so deaf that he could not hear what was addressed to him.
There was no tinnitus in this ear of any kind, nor was there any
feeling of air being passed into the tympanum during forcible
blowing of the nose.
From the train of symptoms thus detailed, I suspected that
there existed intra-tympanal hemorrhage, and accordingly exa-
mined very carefully ; and before doing so I syringed out the
meatus, and then dried it carefully throughout by a dossil of
cotton wadding. On applying the watch, 1 found it could only
be heard when placed in contact with the head. By throwing
a strong Ught along the speculum, I found the lining membrane
of the meatus to be of a uniform redness and very much con-
gested, but no evidence of a solution of continuity in any part of
its structure.
The membrana tympani, instead of its normal, transparent,
gray appearance, had a dull brown colour, and was slightly con-
gested at the margin ; the vertical line, indicating the handle of
the malleus, was lost in the surrounding colour, and the mem-
358 ON DEAFNESS
brane, instead of presenting its concave appearance, seemed
pushed outwards into the meatus. On touching it with a probe
it was almost insensible, and pressure against it produced an
elastic pitting. The lining membrane of the soft palate and
fauces also presented a vascular appearance, but there was no
enlargement of the tonsils. On placing a catheter in the cor-
responding Eustachian tube, and then applying the air douche,
not the sUghtest stream could be made to pass along it into the
tympanum, though 60 cubic inches of air were condensed and
applied in full force. A catgut and also a silver wire bougie were
tried, but without effect ; and failing also to remove the obstruc-
tion by the water douche, I had no alternative but to try and eva-
cuate the cavity of the tympanum hj perforation of the membrane.
The hearing distance on the right side was two inches ; the
membrana tympani was congested and swollen ; and the Eusta-
chian tube was also tender and swollen, and sUghtly obstructed
with mucus, which was easily dispersed by inflation. This
side therefore was evidently labouring under the same a
catarrhal affection as the general mucous membrane of Ji
the fauces, and would require to be treated accordingly. ^^
The head was carefully supported in the hands of
niy assistant Mr Fowler, with the left ear turned up,
and the auricle drawn towards the vertex. The spec-
ulum being introduced as far as the second curve of
the meatus, and then expanded, with a clear and steady
light, the anterior and inferior part of the membrane
was perforated, and a small portion of it removed by an
instrument similar to that represented in the margin.*
On the instrument being passed through the mem-
brane, it felt as if its entire cutting head had got into
the cavity amongst some doughy substance ; and when
the size of this portion of it is considered in relation to
the transverse diameter of the cavity at the point of
perforation, it will be observed that the area of the
tympanum had been considerably increased. Little
pain was evinced by the patient, and on withdrawing the
mstrumen t its surfaces were besmeared with blood. The
meatus was immediately syringed out with water about
90° Fahr., and the first injection, besides being tinged
with the blood-particles from the lacerated membrane,
brought out also a large portion of partially decolor-
ized fibrine from the cavity of the tympanum. This
injection was repeated for about one minute, and was
attended with the discharge of several other pieces of
flocculent fibrine; but giddiness and considerable weight
and pain in the ear coming on, caused me to desist.
L
• The perforator above represented (which has been reversed by the artist
in its cutting edges), is the cutting part of that proposed and figured by
FROM HEMORRHAGE OF THE TYMPANUM. 359
After these had subsided, the watch was reappUed, and the
hearing distance, which before the operation was only in contact
with me head, had now risen to four inches from the auricle.
Pleased with the relief thus obtained, the patient objected to any
thing further being done at present, and I was thereby prevented
from washing out the cavity by means of the Eustachian tube,
which would have been attended with a more speedy and perfect
evacuation of its contents. The fibrine that had been discharged
was collected on a filter, and after being slightly pressed between
the folds of bibulous paper, weighed 9^ grains apothecaries'
weight. Its microscopic characters were very distinct.
July 4. Had spent a good night, but had still a shght de-
gree of pain in the left ear ; no blood had been discharged from
the meatus ; the membrana tympani was red and tumid, espe-
cially around the edges of the aperture, which was still open.
Hearing distance, left side four inches, right side only on contacts
I passed a catheter into the left Eustachian tube, and gently
inflated the tympanum. The air was distinctly heard to pass
into this cavity, and through the artificial aperture into the
meatus. Its course, however, felt considerably obstructed ; but
on being continued for a short time it became more free and of
greater volume, and the gurgling noise attending it at first dis-
appeared. The hearing mstance six inches. Syringed out the
meatus, and brought away a few more shreds of fibrine that had
been dislodged by the inflation. Applied two leeches to either
concha, and a bhster behind either ear.
July 6. Leeches had bled freely, and the bhsters had risen
well. Pain in left ear gone ; its membrana tympani was paler
Deleau,*!* fitted on a solid ivory handle. It consists of a fine but strong steel
needle, two inches and a half long, and the handle of an octagonal f«nn, one and a
half inch in length. The cutting or drill head is spear-shaped, one<4ixth of an inch
long, and one-eighth in breadth at the shoulders where the edges are turned over.
The point and edges are very sharp. Each of these edges is hook-shaped, one
turned forwards and the other backwards ; and when thus viewed longitudinally at
their broadest part, they resemble the italic letter /. On being brought in contact
with the membrana tympani, the handle is made to rotate between the thumb and
fore-finger, and this being communicated to the cutting point, it perforates the
membrane similar to a drill, at the same time that the averted edges are causing a
considerable loss in its substance.
' In most of my operations I have used this instrument, and with every satisfac-
tion. Its length and sixe enable the operator to introduce it with the vtmost secu-
rity along the meatus, and. to place it on a defined spot on the membrane ; and
from the nature and breadth of its cutting, edges, a sufiicient extent of perforation
and removal of the membrane can also be easily effected. In this latter respect,
therefore, it is equal, and in the former it is much superior, to the trochar and
canula of Sir Astley Cooper, or the bulky and complicated punches of Himly, Fa-
brizzi, and Mauoni, or the entire instrument of Deleau ; all of which take up too
much space in the meatus, and most of them require both hands in their use.
•f* Description d'on instrument pour rctablir TOuie. Annales de Plndostrie, tome xii.
rarU, 1623.
360 ON DEAFNESS
and less turgid, and the edges of the aperture nearly in Contact.
Hearing distance seven inches and a half.
On the right side the membrane was only slightly reddened,
and the hearmg distance had become two inches. The inflamed
condition of the fauces and tonsils was nearly gone, and the
catarrhal symptoms had abated. The inflation of the left
Eustachian tube was now easily performed ; but a small propor-
tion of the air still escaped into the meatus. On the right the
muculent obstruction was still present.
Repeated the leeching, kept the blisters open, and dropped
into either ear a solution of acet. plumb, gr. ir. to aq. rossB §j.
July 7. Much improvement ; hearing distance, left side nme
inches, on right two inches. Aperture in the left membran4i
entirely clos^, and the redness and swelling of it diminished.
thicdcened.
Continued the solution, with tepid ablution of meatus night
and morning.
From this till the 21st, inflation of both tympana was used
every alternate day, and the blistering repeated. A gradual
improvement took place in the hearing distances, but chiefly on
the left side. At this latter period it had extended to fifteen
inches^ and on the ri^ht to four. The patient, finding himself
better in his general health and hearing than he had been for
some years past, left this for the country, and since th^i I
have not seen him.
In reviewing the above case there appears to me to be some
important points presented for consideration. In the first place,
I may notice, that no blow or any other recent injury had he&k
received, and consequently the case must be c(msidered, not as
an instance of traumatic hemorrhage such as that of Sir A.
Cooper's, but one of a local and idiopathic form. Out of this,
therefore, arises the question. What was the source of the
hemorrhage? Anatomically considered, it must have been de-
rived from one or other of three sources,— ^/ir^e, from the lining
membrane <tf the posterior nares ; secondly, from that of the
Eustachian tube ; or, thirdly , fi^m that of the cavity of the tym-
panum and mastoid cells.
JFirgty That it might have been dmved from the posterior
part d the middle and inferior meatus is possible, and espedally
from the turgid and congested state in which the general
Schneiderian membrane was at the time ; but this is scarcely the
!>robable origin of it, even admitting the position of the head as
Ssivouring the gravitation of the fluid along the Eostanhian tube.
The overlapjHng and valvular formation of the pharyngeal
opening of this tube, its length and smallness of calibre, with the
surfaces of its walls being always in contact, the obverse direction
of its ciliary movements, and the disadvantageous position of ibe
FROM HEMORRHAGE OF THE TYMPANUM. 361
cavity at its external extremity, all preclude the probability of
the blood having been thus transmitted.
As to the second and third sources of the hemorrhage, I am
inclined to beUeve that both existed, but chiefly in the cavity of
the tympanum. Here the greater proportion of the blood must
have been poured out, and after filling the meshes of the mastoid
cells, it found its way along the Eustachian tube iato the back
part of the left spongy bones, where it had become coagulated,
and formed that which had been spit out in the morning. The
quantity that was removed by the use of the syringe immedi-
ately after the perforation, and the bulged-out condition of the
membrane at that time, indicate that the impaction of the cavity
must have been very considerable. Accepting, therefore, the
doctrine of Morgagni, that in passive hemorrhage there is usu-
ally no erosion, rupture, or any solution of continuity in the
membrane which is its seat, I should view this case as one of
idiopathic hemorrhage, confined to the fibro-mucous lining of the
tympanum and Eustachian tube.
Another point worthy of notice is the time required for the
regeneration of the membrane after the operation. This, in the
present case, occupied about four days and a half, the operation
being performed on the evening of the 2d, and the aperture being
found closed on the morning of the 7tlL This may be viewed
as being about the average time required. In some instances I
have seen it renewed as speedily as the end of the third day,
and in others it was as late as the seventh ; but much of this de-
pends on the previous condition of the membrana tympani. In
the above case, where the membrane was comparatively healthy
and in a good condition for renewal, the time occupied may be
taken as being about the average period that is required.
On the whole, it is an instructive case of the utiUty of a care-
ful ocular inspection and negative exploration of the condition of
the accessory organs of hearing in all ^ases of deafness; and
though it must be confessed that in nuiny instances of such dis-
eases little good can be done, yet in others, and that often where
there is the least prospect, there is often the greatest benefit
conferred on the patient; and, from a state of mental seclusion, he
is again restored to all the pleasures and advantages of society.
50, NoRTHuiaiERi.ASi> Steeet, September 1, 1844.
CcBsarian Section after the Death of the Parent. By William
Campbell, M.D., Lecturer on Midwifery, and Consulting
Phyeadan to the Maternity Hospital, Edinburgh, &c« &e. &c.
Mrs H., aet. thirty, a remarkably robust and muscular sub-
ject, among the indostrious classes, was seized with labour in her
2 z
362 C^SARIAN SECTION AFTER DEATH.
sixth pregnancy, on Monday, August 19, at five a. m. She
was under the care of Mr Robert Menzies, one of my assistants,
who, within the last fifteen months, has witnessed much obstetric
practice, and has had the management of more than one hundred
labour cases. I was not requested to visit this patient until
Friday the 23d at one p. m., when I was informed of the
duration of her labour, which was reported to be considerably
advanced, also that the woman and her friends obstinately de-
chned all interference, and that during a previous labour the
professional attendants were unceremoniously ejected for attempt-
ing to afford her assistance. She had always previously, by
her own efforts, given birth to very large children ; and accord-
ing to the report of her husband, her first infant was equal in
size to many children a year old. Her countenance did not
exhibit any mdication of an untoward event ; the pulse might be
about ninety, and in other respects good ; the skin was not ex-
cited ; there was occasionally shght vomiting ; uterine contrac-
tions recurred at distant intervals, but they were not powerful ;
the abdomen during their absence was fi*ee from uneasiness, as
proved by firmly moving the hand over its parietes ; and she
partook of nourishment as if she experienced very little suffering.
On examination per vaginam, a large 'head with its bones over-
lapping, and the face to the left ilium, was ascertained to have
made some progress into the brim of the pelvis ; but the parietal
protuberances had not yet passed through this aperture. The
patient and those around her were cautioned against further pro-
crastination, and emphatically informed that she could never be
relieved without assistance ; to which they replied, — that as on
all former occasions she had been dehvered without artificial aid,
they were resolved in this labour also to rely on the efforts of
nature. Mr Menzies was now requested to watch her, and to
report any untoward appearance. At one a. m. he informed
me that some unfavourable change must have taken place, as he
thought her sinking ; whereupon I repaired to her house, and
found that she had expired about a quarter of an hour before
my arrival. It now occurred to me, but unfortunately for the
first time, that if I had availed myself of the influence of one of
their clergymen, as the people were of the Roman Catholic
faith, the patient would have been prevailed upon to submit to
the necessary practice ; and there is good reason for believing,
that if embryotomy had been resorted to when I was first called,
the woman might have been saved.
Although I had httle doubt of foetal life being extinct, yet as
the people urged the emancipation of the child, the abdominal
and uterine parietes were accordingly incised, and a large male
foetus, partially decomposed, was readily removed. In dividing
the abdominal parietes, the edge of the knife came very shghtly
in contact with the uterine surface. The abdominal cavity was
CiESARIAN SECTION AFTER DEATH. 363
perfectly free from extravasation of any kind. On penetrating
the uterus, a considerable volume of air escaped, some of the
placental lobes protruded, and the nates of the child, covered
with a large quantity of meconium, were exposed. The facility
with which the uterine parietes were torn by the fingers — the
laceration pursuing the direction of the scratch previously made
by the edge of .the scalpel in dividing the abdominal walls — was
so remarkable that a pathologist might well be excused for
doubting whether the structures under investigation were mus-
cular ; their thickness very little exceeded that of the peritoneum.
After the uterine contents had been removed, the organ con-
tracted to a considerable extent ; and as, from the impatience of
the attendants, a proper examination of the uterine tissues was
not made, I am unable to say what injury these might have
suffered during parturition. Neither can I state whether any
lesion had resulted to the pelvic linings from the protracted
detention of the foetal head ; but it is proper to observe, that
when an examination was instituted twelve hours previously,
these structures did not seem unusually sensitive.
The question naturally suggests itselif — What was the cause of
death ? Did the patient die from exhaustion, the result of her
protracted sufferings? from injury of the peritoneal coat, or
deeper structures of the uterus ? or were the parietes of the
organ perforated at an jr particular point ? Neither the former
nor the latter supposition can be entertained; jirst^ because
when the patient was visited at one p. m. on the 23d, there wa3
not the slightest evidence of exhaustion ; she all along felt desire
for and took substantial nourishment, such as eggs, &c. ; the
countenance was animated, the pulse indicated stamina ; and she
expressed herself, not in a subdued tone, but with resolution and
firmness. I have heard some of mv brethren ascribe the mis-
fortunes of females in child-bed to exhaustion, the result of pro-
tracted uterine action ; but unconnected with uterine hemorrhage,
or some constitutional disease, I have yet to gain my experience
in such cases. It is my firm belief, and I 'feel confident that
those of the profesrion whose opportunities deserve io be appre-
ciated will agree with me in opmion, that the deaths attributed
to exhaustion might, if an investigation had been permitted, be
ascribed to some serious stmctival lesion, as injury to the
uterine tissues, or sloughing of the pelvic Hnings. All men who
have carefully watched during parturition the operation of the
unaided resources of the system, must have been sfrock with the
length of time which, under judicious management, these have,
in occasional instances, been protracted with mapomty* In April
1825, Dr Hedley and Mr Butter, two of m^ asmstaats, watened
during pfiuixirition an unmarried young vigorous female, who
bad strong pains, and whose labour, owing to the Mze of the
foetus, continued for fifty-two and a half boun^ The diild was
364 CiESARIAN SECTION AFTER DEATH.
still-born, and the patient had an attack of emphysema after
delivery ; but at the end of a week her recovery was as satis-
factory as if she had not suffered more than is usual during a
labour of ordinary duration. Dr M*Keever, in his treatise on
Laceration of the Uterus and Vagina, p. 38, gives an outline of
nine cases in which the patients had been in labour from forty-
eight to seventy-two hours, and all of them had ajgood recovery ;
and except one of their number, each produced a living chud.
Some members of the profession boastingly inform us that they
have passed a long course of years in a most extensive field of
obstetric practice without having ever used instruments ; but I
should be very glad of an opportunity by conversation to satisfy
myself whether those gentlemen were capable of using instru-
ments ; and it would also be important to know the amount of
mortality among their puerperal patients.
Secondly, The accumulation of air in the uterus, the absence
of extravasation in the abdominal cavity, and of sanguineous ef-
fusion per vaginam, may all be considered conclusive proofs that
the organ was not perforated either when the patient was visited
on the 23d, or at the time of her decease.
The most legitimate inference is, that this woman fell a victim
to some uterine lesion — laceration of the peritoneal covering of
the organ, or of its deeper structiires. It will be said, jjerhaps,
that when she was last seen there were no symptoms to indicate
that such injuries were either present or impending. It has
been observed, however, and very truly, by respectable author-
ities on the subject, that the phenomena usually attendant on
such accidents are not at all times well marked, — not those even
which distinguish perforation of all the uterine tissues. Dr
Douglas, p. 35, relates the particulars of a case that had been
communicated to him by a brother practitioner, in which, al-
though the uterus had been so far lacerated as to permit the
foetus to escape among the abdominal viscera, and the patient
died some hours subsequent to the accident, the pulse neverthe-
less continued for some hours after the injury " calm and regu-
lar, and the woman complained of nothing except a pain of the
left side below the ribs." Dr M'Keever acknowledges that the
symptoms in every instance are not well defined, that there may
be no constitutional disturbance, and that the contractions even
may continue so vigorous as to accomphsh the expulsion of the
foetus (p. 11). " Les signes, dans tons les cas, sont fort obscurs,
et aucun ne suffit pour etablir un diagnostic certain." (Duparcque,
Maladies de la Matrice, tome ii. p. 35.) Dr Collins, p. 243, ad-
mits that although the symptoms which indicate rupture of the
uterus and vagina are in general well marked, he has " ^een a
few cases where they were very obscure."
Where the injury is limited to the peritoneal coat of the
uterus, or its muscular structure only is impUcated, such cases
C^SARIAN SECTION AFTER DEATH. 365
are attended by some of the more prominent symptoms of per-
foration of all the tissues of the organ, and the consequences
are equally fatal. We may have nausea or even vomiting,
a ghastly appearance of countenance, great prostration of the
vi^ powers, an accelerated fluttering pidse, excessive abdominal
pain, and restlessness ; and the uterine contractions may or may
not be suspended. In a case related by Professor Davis
(Obstet. Med., p. 1067), the labour pains continued ; as also in
three others — one by Mr Chatto (Lond. Med. Gaz. 1832, p.
630) ; a second by Mr White (Dublin Jour. Med. and Chem.
Sci. 1834, p. 325) ; and a third by Mr Partridge (Med. Chir.
Trans., Lond., vol. xix. p. 72). The first example of laceration
of the peritoneal coat of the uterus published in this country,
will be found in* the Trans. Med. Chir. Soc, vol. iii. p. 290, by
Mr, now Sir Charles M. Clarke ; and as the patient died unde-
livered, it may be presumed that the uterine contractions ceased
shortly after the occurrence of the accident. The eighty-sixth
illustration. Part 1st, p. 409, by Dr Ramsbotham, is another of
the foregoing cases ; but in the detail there is no mention made
whether uterine action ceased afterthe accident or not.
I shall not at present enter into any lengthened inquiry re-
garding the causes which, in the cases under consideration, may
produce laceration of the peritoneum. This I believe to depend,
not on uterine distention, nor on blows by the foetal limbs, as
originally suggested by Sir C. M. Clarke, but on a combination
of circumstances, as the conformation of the pelvis, the influence
of inordinate or protracted uterine action, and the long-continued
pressure between two firm structures — ^the foetal head and the
pelvic parietes — of the posterior and lower part of the uterus,
which has in every instance except one been found injured.
The cause of death after rupture of the uterine tissues is an im-
portant question. In many instances this can neither be attri-
buted to hemorrhage nor to inflammation. The loss of blood
generally is far too trivial to account for the fatal event ; and
as, in the generality of cases, the patient dies in a few hours
after the accident, there is not time afforded for inflammation
and its consequences to prove destructive. If we reflect on the
extended connexions of the uterus through the medium of its
. nerves, the powerful influence of its various derangements on
organs which are essential to life, — ^that during pregnancy it is
engaged in the performance of a most important function, we
shall be the less surprised at the formidable effects of such in-
juries as involve all its tissues. The very circumstance of those
lesions of the peritoneum, so apparently trivial, proving suddenly
destructive to life, shows that the uterus, in consequence of ges-
tation, undergoes some remarkable change, and that, though not
a vital organ in the unimpregnated, it is decidedly so m the
gravid state. Sir Charles M. Clarke's patient was in her first
366 CJESARIAN SECTION AFTER DEATH.
labour, which commenced ** at eight a. m., and at half-past ten
she died imdelivered. On turning the fundus of the uterus over
the pubes, the fold of the peritoneum which dips into the pelvis
between the uterus and the rectum, was covered by about an
ounce of blood, and there were between forty and fifty transverse
lacerations, none of which were in depth above the twentieth part
of an inch, and many of them were merely fissures in the mem-
brane itself. They varied from a quarter to two inches in
length." Dr Davis' patient " died three and a half hours after
delivery ; and when the accident happened she felt, to use her
own expression, cw if struck with instant death. In the abdomen
a quantity of dark, grumous, thickish fluid was found, and upon
the posterior wall of the uterus several fissures, one about two
inches in length, which scarcely penetrated the twelfth of an inch
through the peritoneal tunic into the muscular substance of the
uterus." The patient, whose case is related by Dr Ramsbo-
tham, sen., gradually sank from the time of deUvery after a te-
dious labour ; a considerable quantity of blood and bloody fluid
was found in the abdomen, and a laceration of several inches in
length in the peritoneum covering the posterior surface of the
uterus, but the fleshy structure of the organ was not implicated.
Of a similar nature is Mr Chattels case ; the patient died six
hours after deUvery. Mr White's patient died in less than three
quarters of an hour after the birth of the child ; but in this case
it was on the anterior surface of the uterus that the peritoneum
was torn. Mr Partridge's patient died in less than two hours
after bearing twins ; about forty ounces of thin dark-coloured
blood was found in the abdomen, and a number of transverse,
somewhat curved lacerations — some of them resembling fissures
from half an inch to two inches in length — in the peritoneum,
covering the posterior surface of the uterus.
Though the case which precedes the foregoing observations
scarcely admits of any remarks regarding the Caesarian section,
there are one or two, however, which I cannot omit to offer
here ; because, though the points to which they refer are at first sight
trivial, they are nevertheless of great importance. I allude to the
mode of emancipating the foetus after the uterine incision has
been made, and the propriety of puncturing the membranes
of the ovum previous to the operation, that our success might
not be frustrated by the liquor amnii flowing into the abdominal
cavity. Smellie's directions on the subject are exceedingly
vague ; he does not state whether the foetus should be removed
by the head or the feet ; but all the systematic writers since his
time, as Denman, Baudelocque, Burns, Gardien, Capuron, May-
grier, Davis, and Ramsbotham, state distinctly, that after a
breach has been made into the uterus, the foetus is to be removed
bjr the feet. Mr Bell, though ever aUve to the improvement of
his profession, and unquestionably one of the greatest surgeons
CiBSARIAN SECTION AFTER DEATH. 367
of his day, in a case in which he operated, and where the late
Mr Renton, whose dexterity he highly praised, acted under his
directions, the foetus was emancipated by the pelvic limbs (Med.
Chir. Trans, vol. iv. p. 353). Velpeau, p. 852, expresses himself in
the following vague manner : *' Quand il se presente par la tete
ou le siege, on I'entraine dans cette position s*il est
autrement place, on va le saisir par les pieds." If, instead of
permitting the liquor amnii to escape by puncturing the mem-
branes of the ovum per vaginam, before the Caesarian operation
is commenced, as many authorities recommend, the waters are
on the contrary preserved until after the utei:ine incision is com-
pleted, this, by preventing the uterus from contracting, would
certainly faciUtate the subsequent removal of the fcetus, and in
doing so it would, under these circumstances, be immaterial
whether the pelvic or cephalic extremity were extracted first.
But if the liquor amnii is discharged before the operation is
commenced, 1 am satisfied that, in some instances at least, an
attempt to remove the foetus by the feet will, as regards it,
have disastrous results. For, as is satisfactorily shown by the
following quotation, the uterus, during the extraction of the
foetus by the feet, may contract upon its head and neck, while
the placenta may be detached at the same time, whereby both
sources of foetal existence are simultaneously cut off. " The
child was seized by one thigh, and the body was extracted with
the greatest ease, until the shoulders came to pass, when the
uterus suddenly and powerfully contracted, and grasped the
child's neck and left arm so strongly that it could not be Uber-
ated, although great force was used in extraction. The hand
was then gradually passed along the body of the child into the
uterus, and the stricture being dilated the extraction was accom-
plished. It would have been easier," continues the writer, " to
have torn away the uterus from its connexions than to have dis-
engaged the child bv direct extractive force. The fundus and
body of the uterus felt very hard. The child was vigorously
alive when first taken hold oi ; but from the length of time occu-
pied in extracting the head it became so enfeebled as to show
only slight signs of life. Every means were diligently employed
to resuscitate it, and persevered in for three quarters of an hour,
but without success. This was a most appalling affair. After
dividing the funis, the placental extremity was firmly held with
one hand, while the other was introduced into the cavity of the
uterus for the purpose of removing the placenta, which was al-
ready detached and lying loose. The uterus then immediately
fully contracted." — Edin. Med. and Surg. Journal, No. 146. In
the foregoing case the membranes had burst some time before
the operation was performed.
In a conversation which I recently had with Dr Radford
of Manchester, who may be considered a high authority
368 CiESARIAN SECTION AFTER DEATH.
in midwifery, he informed me that, in a case in which he
operated by Caesarian section within the last two years,
and which has not yet been published, there also, consid-
erable difficulty had been experienced in extracting the head,
but that fortunately the foetus had been dead some time
previously to the operation. A similar disposition, though
not to the same extent, was manifested by the uterus in a case
operated on at Paris by Professor Paul Dubois, and detailed in
the Gazette des Hopitaux, Samedi, 23 Juin 1842. The re-
porter of the case, in speaking of the extraction of the foetus, ob-
serves, " L'enfant fut extrait avec facilite en le soulevant par les
nines; on eprouva seulement un pen de difficulte pour extrairela
tete par suite du retour de la matrice sur elle-meme. On a avance
que ce retrait de I'uterus etait tel qu'il devenait quelquefois
necessaire de recourir au forceps pour extraire Tenfant. . . .
Au moment oii les membranes ont ete percees, il est sorti un flot
de liquide qui, grace a la pression qu'un aid exer§ait sur les
parois laterales de I'abdomen, et aux contractions naturelles de
I'uterus, s'epancha en entier en dehors sans qu'il penetrat dans
la cavite abdominale." This last case proves, firsty that by
preserving the liquor amnii until the uterine incision has been
completed, the foetus will thereafter be more easily emancipated;
and, secondly, that by applying pressure to the abdominal parietes
and bringing them into contact with the uterus previously to
puncturing the membranes of the ovum, the waters may be pre^
vented flowing among the abdominal viscera, — the only reason,
I believe, for recommending the waters to be permitted to
escape antecedently to the operation.
EdINBURG"^, 4 PlCARDY PlaCE,
September 12, 1844.
Notice of a Case of alleged Luminous Appearance on the Hani
and other Parts of the Body before Death, in a Letter to one of
the Editors. By Alexander Wood, M. D., Fellow of the
Royal College of Physicians, Lecturer on Pathology and
Practice of Medicine, &c. &c.
Dear* Sir, — It is almost eight years since I received an account of
the death of a person residing in one of the western counties of
Scotland, accompanied with the description of " strange lights"
which were seen to play round her previous to her decease. .
Various speculations were afloat as to the nature of this pheno-
menon, and while some unhesitatingly ascribed it to the effect
of superstition on the imagination of the bystanders, others
thought it more prudent to offer no opinion on the subject.
The story was brought again to my memory on seemg in the
ALLEGED LUMINOUS APPEARANCE. 369
London and Edinburgh Monthly Journal of Medical Science
for October 1842, a review of a work by Sir Henry Marsh oa
" The Evolution of Light from the Human Subject," containingan
account of several cases somewhat similar. Thinking it right to
procure any additional information I could on this curious subject,
1 immediately wrote to the friends of the deceased, requesting a
full account of the circumstances attending her death ; and was
furnished with a reply, which was the more easily obtained, as
those who had seen the lights referred to had drawn up an
account of it at the time, and authenticated it with their signa-
tures.
Various circumstances have hitherto prevented me from mak-
ing any use of the documents which I received in November 1842.
At your request I now send you an abstract of them, without
any comment whatever ; for although I think it right to contri-
bute any thing, however slight, to the scanty information existing,
I have no inclination to commit myself to any opinion on the
iBubject.
The narrative is, as might be expected under the circum-
stances, extremely imperfect, aitd the professional adviser of the
patient had no opportunity of seeing the unusual occurrence.
The patient in whom the lights were observed was upwards of
seventy years of age. The <3ause of her death would appear to
have been exhaustion and some chronic affection of the coats of
the Stomach, probably of the nature of scirrhus. The unusual
appearance was witnessed by five individuals. '^ About eight
o'clock in the evening of the 80th September 1836 (two days
before her death), two persons attending her, and leaning on hep
bed, looked to each oth^* and exclaimed — * What is that ?'
The exclamation was caused by the appearance of a pale flam6
about a foot in length and an kich and a half in breadth, slightly
curved and pointed at the ^^ids, moving -slowly between the pil-
low on which one of her hands haf pened to be lying and the
board at the head of the bed. The flame was sometimes bright
and sometimes faint, and gave a pale yellow colour to the lighter
part of the print hangings of the bed. At times the inside of
the bed seemed lighted as by a lantern, and more than once the
pillow on which her head lay, and her cap and face, became quite
white. She did not se^n aware of the light herself, as on one
occasion when she raised her luminous hand towards her eyes,
one of the attendants interposed hof hand to shade her eyes from
the light, when she immediately put it down. She disliked
light excessively, and the room was all this time kept as dark as
possible. There was a stone wall at two sides of her bed. On
one occasion one of her attendants tied her cap, when the nail of
the thomb became luminous ; there were also dots of Ught ob-
served on the pillow, face, and cap. The body presented no
unusual appearance sifter ckath. The undertaker saw nothing
3 A
370 SURGICAL CASES.
extraordinary, nor did it seem to decompose more rapidly than
usual." Such are the facts as 1 have received them. The ap-
Eearances seem not imlike those observed in the second case re-
tted by Sir H. Marsh; but I beg that I may be regarded
merely as the vehicle of their transmission to you, and not in any
other way responsible for them.
Edinburgh, September 12, 1844.
Surgical Cases — Neuralgia of Stump after Amputation —
Secondary Amputation — Return of the Neuralgia. By James
Duncan, M.D., Fellow of the Royal Colleges of Surgeons of
England and Edinburgh, one of the Surgeons to the Royal
Infirmary, Edinburgh,
J. R., set. forty-five, an Irishman, was admitted into the Royal
Infirmary, under my care, on August 30, 1843.
He had been employed on the Edinburgh and Glasgow Rail-
way, and in August 1840 one of the carriages passed over
the Umb, tearing it oflF immediately above the ankle, and other-
wise injuring it severely. The extremity had in consequence
been amputated by Dr Hamilton of Falkirk a little below the
knee-joint. The case had gone on remarkably well until about
six weeks after the operation, when the stump became the seat
of shght neuralgic pams. These continued to mcrease, notwith-
standing a variety of medical treatment, and at last they became
such a source of annoyance and distress to him, that he was ob-
liged to abandon the situation on the railway, to which he had
returned some time after the operation.
When admitted under my care, the pain was described by
him as being exceedingly severe, more pasrticularly during the
night, and such as almost altogether to banish sleep. There was
not the slightest reason to believe that the patient feigned ; his
employment was by no means an arduous one, he had a family
depending upon him for support, and, above all, his appearance
was that of a person worn out by continued suffering.
When admitted, the stump was carefully examined, under the
belief that the pains might depend upon the divided ends of the
nerves being either injuriously involved in the cicatrix, op applied
over the ends of the bones. Nothing of this kind, however,
could be discovered, no enlargements of the extremities of the
nerves could be made out, and altogether the stump was as well
formed and apparently as serviceable a one as could be met with.
In addition, the pain was not confined to any particular spot, but
affected the whole stump below the knee, very slight pressure
on any point producing very acute pain.
SURGICAL CASES. 371
As his general health appeared to be much disordered, it was
thought possible that hj improving this the painful affection
might be reheved. A shght alterative course of. the blue pill
was accordingly exhibited, with the effect of somewhat improvmg
his general condition, but without any the slightest amehoration
of me local symptoms. This was followed up by the internal
exhibition of tonics, and the other remedies occasionally found
useful in such cases ; amongst these may be named the Quinine,
Carb. Ferri., Arsenic, &c., but all without effect.
Local remedies of different kinds were likewise tried. At first,
as there appeared to be some shght fulness with increased heat
of the parts below the knee-joint, leeches in considerable numbers
were appUed, and these were followed by a succession of blisters
to the part. For a time the blisters appeared to act beneficially,
the pain being reheved, although by no means removed, for a day
or two after their application, as long as the discharge produced
by them continued. Even this shght temporary relief, however,
speedily ceased to follow their employment. The painting over
the parts with a strong Tinct. of Iodine was next tried, and like-
wise with temporary relief, and that of longer duration than
followed the use of the bUsters. This application also soon failed
to have any effect, and various anodyne remedies were next
tried, but without their having the slightest influence.
On the whole, the severity of the symptoms continued to in-
crease, and the tenderness became so excessive that even the
drawing of a feather over the surface of the stump made the
patient shrink. His appearance became more haggard, the ex-
pression of his face more anxious, his appetite became more and
more impaired, he was worn out by want of sleep, and he
became much emaciated.
From the time of his admission into the hospital, the patient
had been incessantly urging me to remove the stump, a request
which I was exceedingly unwilling to comply with, inasmuch as
I did not believe the operation would be followed by any benefit
at all proportioned to the risk incurred.
When, however, all the means I could think of had been
tried, I was reluctantly compelled to think of having recourse to
this step ; and as the patient himself was more and more urgent,
it was determined, after a consultation with my colleagues, to
give him the chance afforded by amputation higher up. I
explained to the patient the risk he incurred by the operation,
and likewise the possibihty if not the probability of the pain
returning in the new stump. He was, however, determined on
having the amputation performed, and stated his resolution, if we
refused to comply with his wish, to leave the hospital, and find
some surgeon who would.
Amputation above the knee was accordingly performed on No-
vember 16, The patient endured it manfully, and when carried to
372 SqRGICAL CASES.
bed, expressed himself as delighted with the relief afforded.
The parts removed were carefully examined. The articulation
was anchyloaed, and free from any existing disease. The ex-
tremities of the nerves w^e thickly imbedded in soft parts^ and
the enlargements, almost invariably found after amputatioa^
existed to oven a less extent than is iisually the case.
Every thing went on favourably for a time after the operaiioR.
The $tump healed with great rapidity, and foir soioe tea wadks
the patient remained perfectly free from pain ; be was in high
spirits, his appetite exceedingly good, and his appearance was
that of a person in robust health. The patient himsdf
chuckled at the idea of having known better than the doetora
what treatment was necessary in his own oase, and we wer^
beginning to think that a permanent cure had in reality been
effected. About the tenth or eleventh week, however, the
patient began to complain of some slight pain in the stump» but
was exceedingly unwilling to believe that it at all resembled that
under which he had previously laboured ; indeed, it was not
until the lapse of ten days or more, when it at hat became too
severe any longer to flatter himself that it was not, that he would
admit it. The same treatment as formerly was again tried, and
with much the same result, the blisters perhaps affording more
relief than before. In addition, bUstering the spine was tried,
but without the slightest effect. The tincture of AconiAe was
likewise given internally in doses of g***. v„ three times daily,
and certainly for a time with very marked benefit ; but the
effects produced by it on his general health, even in diminished
doses, were so injurious, that we were obliged to discontinue it.
We next tried its local application, and likewise with benefit to
the local affection ; but it still exerted the same prejudicial effect
upon the general health, again obliging us to abandon its use.
In consequence of the. relief afforded by the discharge produced
by the blisters, I was induced to try the effect of a seton, and
one was accordingly passed through the anterior part of th^
stump. After this- had produced pretty free suppuration* the
pain began to abate, and tha patient remained for about a fort-
night much freer from it than he had been under any oth^
form of treatment. This, however, likewise began to lose i^
influence ; and finally, as it appeared altogether to have lost it, it
was removed by the patient himself.
The patient is now in very much the same state, in so far as
the neuralgia of the stump is concerned, as when he entered tb«t
hospital, but certainly not suffering so severely from the pain as
immediately before the performance of the operation, although
I have reason to fear that in time he may.
I should have mentioned that the pain at present does not
involve the whole surface of the stump as formerly, it being
confined in a great measure to its outer and posterior part, and
SURGICAL CASES. 373
likewise, that it is produced by pressure over the whole extent
of the sciatic nerve, the muscles at the same time being thrown
into violent spasmodic action.
Cases of irritable stump are fortunately not of very common
occurrence, and are perhaps not so frequently met with as
formerly, a circumstance wEch^has been attributed to the im-
provements which the operation of amputation has undergone
in modern times. They are mentioned by Mr Listen a3 being
more frequently met with after amputations of the forearm and
arm than any other ; this may be correct, but I have my-
self seen them more frequently perhaps in amputations below the
knee. The pain in different cases varies in extent ; it may
invdve the whole circiunference of the stump, it may affect only
a particular spot over the extremity of the nerve, or it may ex<«
tend, as in the case I have related, along its whole course.
The period after the operation at which the pain maj occur
varies much. Thus in the man Rice it commenced anout sax
weeks afterwards ; in a man upon whom Mr Mayo had
operated, it began about eighteen months after the amputation ;
and in another, whose leg bad been removed by Sir B. Brodie»
it did not make its appesurance until after the lapse of -seven
years.
In some cases the irritability of the stump may depend upon
merely local causes, but in otners again there would appear to
be, as has been said, a constitutional and innate tendency giving
rise to it. The extremity of every nerve after amputation
swells into a bulb of greater or less size, which possesses con-
siderable firmness, being sometimes almost cartilaginous in its
structure. It was at one time thought that the mere existence
of these bulbous swellings was sufficient to account for the oocur-
r&oiee of the pain ; this, however, is far from being the case, as we
not unfrequently find these tumours of very large size 'm stumpa
which had never been the seat q£ uneasy sensations ; and on the
other hand, they are sometimes comparatively small, in cases in
which, as in the present case, great irritability had existed.
Should these sweUings, however, be involved m the cicatrix
near the sur&ce, or by ite contraction, as suggested by Mr
lAun^Qiee, be pressed against the sawn end of the bone, then
irritabihty of the stump is extremely likely to follow* These
conditions of the nerve, with perhaps, in some cases, a degree
of chronic inflammation of its proper tissues, or its neurilemma,
are, it is generally allowed I beheve, the most frequent causes
of those cases of irritability of the stump which are local in
their origin; and are the only ones, I would say, which can be
permanently relieved, either by a secondary amputation, or by
excision of the extremity of the nerve, these being the operationsi
recommended in such cases. The latter operation is of course to
be preferred in those cases in which the symptoms are '' cloa^ply
374 SURGICAL CASES.
attributable to an aflFection of one nerve only. That in certain
eases the pain is dependent upon purely local causes, is fully
established by the complete and permanent relief which has
followed either the one or other of these operations, although,
it must be allowed, in some of the recorded cases it would have
been well had they been watched for a longer period than they
appear to have been. There is no Umit, we have seen, to the
time after which the pain may occur after a primary amputation,
and as little is there after the secondary operation. In the
case I have recorded, for instance, the patient might have been
dismissed the hospital, and regarded as cured, had I not, from a
suspicion I entertained as to the ultimate result, detained the
man much longer than was required by the existing state of
matters; no return of the pain having taken place until after
an interval of ten weeks.
The cases which are to be included under the second head, those
which are not dependent upon merely local causes, are fortunately
comparatively rare; still, however, they are occasionally met with,
and many of a very distressing character have been recorded. In
these we have nothing in the formation of the stump to account for
the occurrence of the pain ; bulbous swellings, it is true, may exist
on the ends of the nerves, but we have seen that the mere presence
of these has nothing in itself to do with the existence of the pam ;
and in the cases which I would include under this head, there
has been nothing in their condition to account for it, and, above
all, the result of the treatment has shown that the symptoms did
not depend upon merely local causes. In the case of Ilice, the
enlargements were smaller than usual, not impUcated in the cica-
trix, and not subjected to injurious pressure against the end of
the bone. In the two following cases, as related by Mr Mayo,
there was likewise no local cause to account for the occurrence
of the pain. This first case, we may remark, affords us an in-
structive lesson as to the impropriety of having recourse to am-
putation in cases of neuralgia of a joint.
** H. A., aetat. twenty-two, the catamenia regular, having suffered during
four years pam in the knee-joint, which, although sometimes greatly miti-
gated, never entirely left her, at length, when every remedy that could be
thought of had been tried, and the pain had much increased, underwent am-
putation of the leg. The symptoms had been pain and increased sensibility,
and nothing more ; the joint, with the exception of slight oedema arising per-
haps from the local remedies, had not swollen, nor had there been any me-
chanical impediment to motion. On examining the amputated knee, which
had been previously injected, the capsular synovial membrane was found
of a bright red. The synovial membrane covering a small part of the
semilunar cartilages was likewise very vascular. At the upper part of
the patella, the same appearance was seen ; towards the lower piut, the
synovial membrane, for the extent of five lines by two, was not only red
with injected vessels, but considerably thickened.
« These appearances admit of being interpreted in two ways. The in-
SURGICAL CASES. 375 *
creased capillary vascularity of the joint may have been either the cause of
the pain this patient suffered, or an effect of it. I am inclined to adopt
the latter supposition. It is certain that influences upon the nerves are
capable of producing, not pain alone, but even swelling about a joint : it is
thus that, in hip disease, the knee often becomes affected with symptom-
atic swelling, in conjunction with pain and tenderness. The further pro-
gress of the present case seemed to show that the disease had been in the
nerves, not in the organization of the joint. Soon after the stump had
healed, it was accidentally struck. To this cause, probably without reason,
the patient attributed a return of pain exactly similar to that which she
experienced before the amputation of the leg. When the pain had gone on
several months increasing in severity, the patient^ anxious at any expense
of immediate sufiering to get well, submitted to another operation. The
pain and tenderness were seated in the last three inches of the stump, not
more upon one aspect than another, although most acute as it seemed in
the part of the cicatrix covering the bone. The extremity of the stump
was therefore amputated, a second portion of bone sawn off, an additional
portion of the sciatic nerve taken off in the operation, and the bone and
nerve buried in a full bed of relaxed muscle and integument. On examin-
ing the part removed, the sciatic and the saphenus nerves were found to
terminate in large white cartilaginous bulbs, behind but not adhering to
the cicatrix. It is distressing to have to relate, that, on the stump healing,
the pain recurred. After some months, the pain continuing, the sciatic
nerve was divided under the edge of the gluteus muscle. Again, that is,
.while the wound was green, her sufferings were mitigated ; on its healing,
they have recurred. It is needless to say that every remedy, local and
general, upon every plan, and the intermission of all remedies, were tried,
before tiie repeated operations were resorted to."
** A man, about thirty-five years of age, was admitted into the Middle-
sex Hospital in the course of the last autumn, whose leg I had amputated
below the knee, for compound fracture, about two years before. It was,
to the best of my recollection, half a year before the readmission of this
patient that the stump began to be painful. The pain was described as a
constant and severe gnawing pain : it was principally felt at the end of the
fibula, from whence it extended to the knee and ham. The cicatrix cover-
ing the end of the fibula was exquisitely sensible, and the muscles of the
stump were in a state of perpetual quivering : the cicatrix appeared to
grin, from the successive traction of different packets of the muscles. Sup-
posing the symptoms to depend upon an enlargement of the end of the
superficial peroneal nerve, I cut down to the fibula, and removed about the
half of a square inch of integument and cicatrix covering it, with half an
inch of the fibula, and some thickness of the flesh attached to it, including
the superficial fibular nerve. The end of this nerve was found to terminate
in a small bulb behind the cicatrix.
^ The severe pain which the patient had suffered for months was instan^
taneously removed by this operation. While the wound was healing, how-
ever, some pain and tenderness reappeared in the direction of the fibular
nerve : but on applying leeches, and administering calomel every night for
a week, these symptoms went away, and the patient left the hospital almost
firee from pain in the stump ; but a little of the quivering remained, with
slight tenderness of the original cicatrix opposite to the iitiiaiion of the
tibial nerve."
' 376 SURGICAL CASBS.
In the first of these cases^ it is perfectly evident that the
symptoms did not depend upon merely local canses ; but if any
room for doubt remained after the prunary amputation, this was
completely removed by the issue of the secondary one, and the
precautions taken in the latter. The second case, it appears to
me, was likewise one of the same description, the whole history
leaving no doubt upon the matter.
The period after which, in cases of this kind, the irritability
may supervene, appears to vary much, as I have said, both
after the primary and secondary operations* Most generally,
however, after the secondary amputation, it commences either
when the healing process is nearly completed, or at least within
a short time afterwards, the patient in the interval, genersdly
speaking, remaining free from uneasiness. In the present state
of our knowledge, it would be useless to speculate upon the causes
of this irritability. By some the cases are regarded as very
analogous to those of spinal irritation, and certamly, in one case
related by Mayo, he mentions that he thought he detected some
tenderness at one port of the spine ; however, treatment ap-
plied to this part appeared to exert no influence whatever over
the disease. In Rice nothing of this kind could be discovered.
In most cases the symptoms appear to be intimately connected
with some derangement of the general state of the health, but
whether as a cause or effect it is often difficult to say.
The treatment in the first class of cases is obvious, and has
already been alluded to : it consists, as I have said, either in
performing a secondary amputation, or in excising the bulbous
extremities of the nerves. The success of the treatment in these
cases has been well established. The same cannot be said of any
treatment whatever in the latter class of cases, as all the remedies
which have been employed in different cases, although in the
first instance several of them have appeared to afford consider-
able relief, have after a short time become equally powerless.
The greater number of the remedies generally employed in
these cases were tried in this one, but all without permanent
benefit following their use.
As to the propriety of secondary amputation in these cases,
there can be no difference of opinion, when the surgeon is con-
vinced that the symptoms depend upon constitutional causes ;
and in this case I would never have had recourse to this step,
had the possibility of their depending upon local causes been
altogether bej^^ond doubt. After all the remedies employed had
completely failed, I did, after considerable hesitation, decide
upon giving the patient the chance afforded by amputation ; but
now that the nature of the case has been, as I believe, com-
I)letely decided by the issue, nothing would induce me a second
time to have recourse to it, although the patient himself now
strongly urges it, and is more than willing to run the risk of a
SURGICAL CASES. 377
third amputation. In almost every case, relief for a longer or
shorter period has been afforded by the operation ; but then we
have seen that it is but of short duration, and not at all propor-
tioned to the risk run. Mr Mayo, however, I find from the
report of the case already referred to as operated upon by him,
is not very strongljr opposed even to a third or fourth opera-
tion, and the following are his reasons : —
** I suppose it to be possible that, in this case, the seat of irritation may
be confined to the trunks of the nerves in the limb, and that their origins
may not be engaged. If it were so, amputation at the hip-joint might cure
this patient. But I am loth to recommend this formidable operation, as it
might prove as useless as those which have been already sustained. My
reason for conjecturing the seat of the irritation may possibly not extend
beyond what remains of the limb, is the following case,
" I had about three months ago under my care, as an out-patient of the
Middlesex Hospital, a woman whose arm Mr Bransby Cooper had ampu-
tated at the shoulder-joint for neuralgia, which had followed an amputa-
tion above the wrist, and had returned after a second amputation above the
elbow. She told me that she was perfectly cured, by the third operation,
of the pain she had undergone so much to get rid of."
Paet IL^REVIEWS.
1. Homasopathy Unmaskedy being an Exposure of its Principal Absurdities
and Contradictions: with an Estimate of its Recorded Cures, By
Alexander Wood, M.D., F.R.C.P., &c. &c.
2. Defence of Hahnemann and his Doctrines: including an Exposure ofDr
Alexander Wood's " Homxopathy Unmasked/'
3. Sequel to HomoBopathy Unmasked.; being a farther Exposure of Hahne-
mann and his Doctrines, in a Reply to recent Anonymous Pamphleteers,
By Alexander Wood, M.D., &c. &c.
4. A Medical Visit to GrOfenberg in April and May 1843, for the Purpose
of Investigating the Merits of the Water-Cure Treatment. By Sir
Charles Scudamore, M.D., F.It.S/, &c.
The subjects on which the popular mind ^is exposed to delusion become,
with the spread of knowledge, progressively circumscribed. The time was
when the best informed of an age found it easy to believe that the incidents
of a man's life or the events in the chronicles of a people were determined
by the course of the stars ; nay even, though not probably without an occa-
sional struggle of doubt, that the future is prefigured in the direction of a
thunder-clap, in a shower of stones from the air, in the flight of a bird, or
in some trivial peculiarity of an animal's entrails. And not only by such
observations that the future could be anticipated, but even subjected to the
will of man, by means which, in comparison with the alleged eJBects, show a
3 B
378 LAST OF GROSS POPULAR DELUSIONS
disparity like that which exists hetween the modem homoeopathic infini-
tesimals of drugs and the known power of resistance in the living frame
to external agents, for example, that the moon could he drawn from her
orb by the help of a fragment of some insignificant herb, — .
Te quoque, Luna, traho.
These, and an infinite number besides of long-cherished follies, have
mouldered away before the growth of knowledge — ^before the difiiision
abroad of a slight smattering of the laws to which the course of nature is
obedient. The average amount of information in such a subject as as^
tronoray, meteorology, natural history, or anatomy, which falls to the
share of each individual, even among the educated orders of society, is
trifling in the extreme. Yet that trifling allowance avails to beget a
spirit which, by reflection from mind to mind, gathers, in all but the
weakest within the sphere of its influence, a force to resist the fascinations
of those delusions to which the strongest minds among our remoter pre-
decessors fell an easy prey. In short, the past history of the objects of
man's belief unequivocally shows that it is not depth of penetration, refine-
ment of reasoning, or unwearied reflection, but a spirit readily springmg
from knowledge, by which he is emancipated from a slavery to the grossest
errors. Nay, these high qualities of mind, in the absence of a firm basis of
knowledge, are too often observed to lead men's minds farther astray.
Of the delusions in question there are two principal sources often
blended together. Thus, man's ardent curiosity to discover new sources
of relation among the events or objects coming within his view, leads him
to invent imaginary bonds of relation when he cannot reach the truth.
And his facility of belief on all subjects of the true nature of which he is
ignorant, makes him ever ready to listen to pretended discoveries, and to
become the dupe of interested parties, if they take but very small pains to
suit their inventions to the taste which prevails with him at the moment.
On such occasions he believes what is affirmed, not merely because by the
constitution of his mind he feels dissatisfied till he has discovered some
kind of relation among the objects of his perceptions in general, but be-
cause he cannot help believing whatever is affirmed strongly, unless he has
learned to distrust the individual who affirms, or unless what is affiimcd be
incompatible with some part of his previous knowledge or persuasions. So
long, then, as there were numerous sets of events and objects, the true links
of relation among which were undiscovered, there being always designing
persons on the watch to turn the present current of popular feeling to their
own advantage, men were kept in fast bondage to such delusions as those of
astrology, divination, sorcery, and magic ; and the same bondage would
have remained unbroken for a much longer period, did it not fortunately
happen that the light which springs from knowledge sheds its lustre far
heyond the ranks within which exact knowledge is confined.
Man is so much of an imitative animal, that he catches up his neighbour's
spirit, even on points that he understands but imperfectly. Or the sym-
pathy between mind and mind, through imperceptible links, is not confined
to such cases as the rapid propagation of panic. terror over a crowd of
people. There are also slower influences by which one intelligence acts
upon another, so that, without direct instruction, numbers are already pre-
pared to apprehend at once the scope of a new subject of study before ap-
plying themselves to it, and to become imbued with it« spirit, provided the
society in which they live includes a cei'tain proportion whose minds have
QUACKERY IN DISEASES. ' 379
been already operated on by the sentim^itSy precepts^ or principles bn which
that dtitdy is based. And the converse of this is true — ^that when a kind
of knowledge at all complex is successfully cultivated by a small piopoif*
tion of persons, or when such a subject comes to ^igage attention in a
society, among few of the members of which it was till then received, ita
progpress among ihem is inconceivably slow^ and beset with obstacles a4
every step.
It would be easy^ did the time permit, to illustrate this subject with
copious examples^ a&d to point out the momentous bearings of this general
Act on all the efforts made to ptomote the mental improvement of bo^es
<^men»
And those who liave been accustomed to contemplate the prodigious
effects of this principle, when happily it has come to operate in a right.
direction, and to view it as the strongest motive to perseveiatice, amidst
the deepest discoun^ments^ in any WelUconsidered plan to extend the
culture of the higher meiital susceptibilities, cannot but be struck with
any instance of its apparent failure under circumstances where tiiey should
have expected to see it manifest its fullest force.
The works at the head of tliis article point to the department in which,
up to this time, there has been, to all appeanmce, a remarkable tardiness in
the display of Uie effects of this principle* Quackery in- diseases maintains
its empire even in this enlightened age. Though hardly less of a delusion
than astrology or divination, it holds up its head among the educated orders
of the community. This itarprises us when we advert to the great multi*
plication of sound medical pmetitioners, men of education and intelligence^
who live on terms of the strictest intimacy with patients of all ranks^ and
thereby, it might be supposed, according to the view just enunciated, should
be exactly in the situation to influence favourably the public asind for the
ready apprehension and reception of medical trutli.
To what cause, then, does quackery owe its continued existence in our age^
notwithstanding these circumstances so propitious to popular instruction !
If it be, as we truly believe, a delusion analogous to the obsolete infSsttua*
tions of former times— -as^ology, divination, and soroery-^t must be owing
to a continued slowness in the capacity of the popular mind to af^reheEnd
the just q>irit of medicine, — ^to appreciate the real nature of disease,*-'Huid
to catch up the limits within which remedies must operate. When the
subject is duly considered, no alternative presents itself. And the less rooia
exists fbr surprise when there is taken into account the extreme difficulty
^ understanding the true nature of medicine, and the assigned limits of its
powe^ over dideases, and at the same time, the prolific nature of quackerjT
viewed in the abstract, which, hydra-like, still reappears, though without
ceani^ struck down, while at each Ireappearance it puts on soitie new, move
secret^ or yet unrecognised form of disguise. In short, whatever relates to
diseases and remedies rests on the laws of life, the most embarrassing of all
the subjects of nian's studies. It is not wonderful, therefore, that the po-
pul»r mind should be a great deal more tardy to imbibe the genuine spirit
of the course of living action, than to catch up the simple light of physical
nature. Or the state of the case at present is exactly what might have beea
foretold some ages ago. Thus, as men are no longer so little acquainted
with physical nature thfi^ they can be duped on the subject of the stai%
meteoric phettomenlt, or the like, the more ambitious Sidrophelsof the day
feel compelled to exercise their tactics on what topics are stiH sparingly
understood^ and to impart to their systems of quackery, in eoknplianee with
380 LAST OF GROSS POPULAR DELUSIONS
the requisition of the age, some appearance in the distance of a Baconian
hue — something representing to the inexperienced eye the colour of induc-
tive science.
And we may rest assured that quackery will not cease to prosper under
some one of its many disguises, as long as men in general remain so little
acquainted with medicine, and, we may add, with the medical profession.
We say with the medical profession ; for, after each defeat, quackery suc-
ceeds in recovering its ground in no small measure, hecause the public in-
considerately impute to the medical profession as a body all the follies,
weaknesses, and inconsistencies discoverable in individuals within its circle,
which belong to them, not in virtue of their medical character, but as weak
or wrong-headed persons among their fellow-men.
As this subject so intimately concerns the public, and as we wish to throw
out some hints of a very general nature for the purpose of putting people
on their guard against the cunning devices of quackery, we beg permission
of our medical readers to speak throughout the rest of this article in such
terms as the public can understand.
Disease is a part of the inheritance of our human nature. The stmcture
of our living frame, and the ever-varying outward circumstances under
which we are placed, render diseases not less inevitable than ordinary bodily
accidents. And when diseases have arisen, they must, for reasons not less
intelligible than in the case of accidents, prove fatal in many instances. In
short, at variance with the flattering insinuations of quackery, the human
race is indisputably so circumstanced that numbers must be cut off by dis-
eases before the period for the death of age arrives.
The parallel between external injuries and internal diseases is in many
respects much more close than it appears to be at first sight— nay more
perfect than, for reasons of temporary influence in the progress of medi-
cine, it is allowed to be by some medical authorities of distinguished name.
This we remark here, because we have observed that sounder sentiments
prevail in the public mind, in regard to the healing of wounds and other
injuries, than as respects the i-ecovery from- internal diseases. We r^;ard
not merely the medical profession but the public nearly at large as now
fully impressed with the great truth on which the whole of the modem
surgery of injuries is- based, namely, that the repair of a breach depends,
not on the applications made by the surgeon^ but on the spontaneous exer-
tion of healing powers inherent in the living system. Moreover, that these
powers are liable to interruption, retardation, or total fiulure, from the ever-
changing circumstances of previous health and present external agencies.
That the duty of the surgeon^ embarrassing as that sometimes is, limits
itself to placing the patient under those conditions, whether ofsa positive or
negative kind, which have been found by the experience of past times most
conducive to the free exercise of the healing powers inherent in the system.
In regard to internal diseases, when curable, it is not to be doubted that
recovery is in a great measure owing to«the operation of analogous. powers,
though, on account of the extravagant ideas respecting these embodied in
some obsolete theories, pathologists are at present, with reason, jealous of
much reference to a " vis medicatrix naturae."
But the disposition in the living body, through its own inherent suscep-
tibilities, to a revolution from the state of acute disease to a state of health,
cannot be disputed for a moment, though, at least in civilized life, the
Busceptibilities called into operation often require direction or moderation
4o prevent their excess from producing new mischief. And in chronic
QUACKERY IN DISEASES, 381
diseases, the chief groundwork of sound treatment is to remove sources
of irritation, to husband and promote the vigour of life, so as to give
free scope to the sanative efforts of nature.
In short, the same power or aggregate of powers resident in the living
body, by which it is developed from an invisible germ, maintained in ito
mature state, and finally carried through the process of decay, has also the
office, within assigned limits, of rectifying the faults to which its intricate
machinery is liable, whether these be discoverable in its visible fabric or
inferred &om derangement of action.
It appears, then, that it is quite coiTcct to represent the body, within
itself, as provided with a power, not only to repair injuries, but also to
recover itself from curable diseases, which power or powers in no respect
originate from any arts of medicine or of quackery, being subject merely
to modification, whether for good or for evil, under the influence of either ;
and that the use of treatment is merely to afford free scope to this
natural tendency to recovery, whether from injury or disease, or to
relieve the living frame from such embarrassments as may interfere with
its sanative efforts. Quackery pays allegiance to no such power. It
professes to coerce nature, — ^to expel the disease by the overpowering
force of a nostrum. And since the natural disposition to recovery under
favourable circumstances seldom enters into popular views of the cure of
diseases^ it too often succeeds in persuading the world that, without such a
nostrum, recovery would not have taken place. On the contrary, the
sound-minded regular practitioner acknowledges this sanative disposition as
the sole power through which his remedies can operate. All his prescriptions,
whether for internal or external use, are directed towards the removal of
whatever present obstacles may interpose between the disease and the free
exercise of this power ; in which is included the separation of parts past
recovery, when that is practicable. He is ** naturae minister/' the servant
of nature.
If there be any method of making it clear, whether the right method
of cure in diseases belong to quackery or to regular medicine, it must
be the consideration of what is the true nature of dise&se. In the popular
illustration of such a subject there is much difficulty ; yet we think that a
few slight notices of some prominent groups of maladies will avail to show
how inadequate quackery is to the efficient treatment of diseases.
Among the simplest of all morbid states are the effects of poisons.
These effects consist of a series of actions and reactions, \vhich sometimes
cease with the evacuation or neutralization of the noxious substance, when
that is immediate, or else, owing to the production in the mean time of less
transitory alterations, become perpetuated after its direct operation has
ceased. And this secondary operation of the poisonous agent goed on either
till death take place, for example by exhaustion, or under more favourable
circumstances, till the state of health is renewed by the self-healing
power of nature. For some poisons there are antidotes, or chemical sub-
stances which, if swallowed quickly, neutralize the hurtful effects of the
poison. But there is no universal antidote, like what quackery often
boasts of. There is, in a word, no philosopher's stone either against poisons
or against diseases in general. Where an antidote exists, for the most
part it is proper to one poison ; in rare cases one antidote counteracts
several poisons.
A review of the effects of poisons affords a parallel to all those apparent
uncertainties and anomalies which give so much intricacy to the history
382 LAST OF GROSS POPULAR DELUSIONS —
of diseases in general, or rather we should say to whatever concenis
organic nature as contrasted with the simplicity of physical nature.
Thus, to confine ourselves to the efiects of a single poison. One patient
dies from a small quantity, another escapes from a large quantity ; one re-
covers without treatment, another dies from no greater quantity, in defiance
of the most careful treatment ; one dies in a few hours, another not for
several days ; one recovers after a few hours' suffering, another not till
after many days or even till after weeks or months of illness.
Inextricahle as the difficulty here presented seems to be, it is nothing
greater than what occurs almost uniformly in the examination ef the
course of diseases and the effects of remedies. And so discouraging *
prospect does it offer to some minds, as to hurry them in disgust into a
scepticism as to the usefulness of medicine. But it is to be remembered,
that there was a time tvhen the occurrences of physical nature presented
a confusion hardly less inextricable ; nor was it in such a temper
of mind that the order and symmetry of the material universe was made
to dawn on mankind.
All the above difierences of effect undoubtedly acknowledge a corre^
sponding difference in the operation of the cause. And this proposition, not
less indisputable than that every occurrence in physical nature has a cause,
at once forces out the inference, that the power to produce determinate
effects on the living body in individual instances, as in the example of
applying remedies to cure a case of disease, is not to be obtained by
generalities such as quackery deals in, but only by the greatest possible
attention to all the particulars within one's reach, as respects the patient,
the disease, and the remedy, the precepts for the attaimnent of whic^ make
up the chief part of regular practical medicine.
Accordingly, it sometimes happens that when there is access to the par-
ticular details of a series of cases, like those of poisoning just instanced, a
good deal, and occasionally the whole, of the apparent contradictions dis^
appear, because variations in the minuter and less obvious circumstances
are brought to light, such as in the examples referred to would be, the
state of the stomach as full or empty, the kind of food with whick the
poison was taken, the previous health, the tendency in the individual to
vomit, and the like. Again, notwithstanding the ill success of regulaf
treatment in some examples of poisoning, and the recovery without treats
ment in others, it will be found that, out of a given number of cases, the
bulk of the recoveries are those in which early and judicious treatment was
resorted to. And thb is exactly parallel to the statistics of diseases in g&ie-
rai, in the hands of regular practitioners, when computed over the com-
munity at large, and not according to some exclusive plan, contrary to what
is asserted by mountebank pretenders and wrong-headed people^ whether in
or out of the profession.
Besides poisons strictly so called, there is an order of noxious i^ents^ the
effects of which are familiar to the public, namely, thepoisonouseauses of small*
pox, measles, and scarlet fever. From the brief consideration of these, in
two or three respects, we think may be drawn some intelligible illustrationB
of the soundness of the views adopted in regular medicine regarding the
nature and treatment of diseases.
The subtile causes of small-pox, measles, and scarlet fever, produce seve*
rally very definite trains of symptoms. Or the poison in each of those dis-
eases gives birth to a succession of actions and reactions of nearly uniform
duration in every individual attacked. And the train of actions and
QUACKERY IN DISEASES. 383
reactions constituting each of those diseases tends to terminate in health.
And when any one of them fails so to terminate, the fatal event must be
owing to an exhaustion of the self-healing power under the complexity of
the efforts required of it, when circumstances, whether applied from with-
out or originating within the body have not been propitious. That is to
say, diseases of this kind destroy life owing to the coincidence of unfavour-
able circumstances with the operation of the poison from which each originates.
Death takes place when any one of these subtile poisons acts on a consti-
tution before deranged or tending to become unusually deranged, whether
by the simple agency of the poison, or, as at other times, by the joint
agency of the poison and of some separate incidental condition or conditions
of a hurtful character. Of these we obtain examples in pestilent atmosphe-
ric influences, insalubrity of situation, and unskilful treatment.
It is hardly paradoxical to affirm that neither small-pox, measles, nor
scarlet fever, requires, in itself, any treatment. For the use of treatment
is not on account of any fatal tendency in these curable diseases themselves,
but owing to the accidents of ever- varying complexion to which the consti-
tution is more or less subject during the presence t>f each.
Among the most serious constitutional accidents to be apprehended are
exhaustion, putrescence, and over-excitement. And every one of these states,
if it cannot be counteracted in its incipient stage by appropriate means,
grounded on long experience, and different in each, is too apt to determine
a fatal event.
Pluming itself on its contradiction of medieal experience, quackery holds
up one mode of treatment in all cases known by the same name, careless of
the tendency of the danger, or whether it lie in exhaustion, in putrescence,
or in over-excitement. And the occasional appearance of success on the
part of empirical pretenders is owing either to the disease being spontane-
ously recovered from in spite of countervailing treatment, or to a fortuitous
coincidence between the nature of the existing epidemic and the kind of
treatment, whether that be stimulant and cordial, or depletive and refrige-
rant, on which the particular quackery resorted to relies. And, luckily for
the cause of quackery, though unluckily for the progress of sound thinking
in the public mind on medical topics, epidemics often retain one character
for a series of years. Hence, if quackery has begun with a mode of treat-
m^t in some respects appropriate to the prevailing type of an epidemic, it
may be some years, or as many years as one kind of quackery usually lasts,
before the fatal consequences of the indiscriminate employment of that
treatment be fairly exposed. For those alone will fall victims, on the sup-
position made, whose cases prove exceptions to the general rule ; or who,
during an epidemic marked by one general character, as of exhaustion,
putrescence, or over-excitement, have from special causes become affected
with a malady of an opposite type. On the contrary, a judicious medical
man, who is always on the watch for such exceptions, is often able to save
the patient by varying the treatment to suit the specialties of the case.
If our readers will extend to us a little further indulgence, we will en-
deavour to point out to them the bearing of acute inflammation on our
present purpose.
Acute inflammation is at once the character of the greatest number of
fatal affections of short duration, and that kind of deviation from health
which is most within the control of judicious treatment. And the corol-
lary follows that it is the description of malady in which quackery makes
the greatest havoc of human life.
384 LAST OF GROSS POPULAR DELUSIONS
In general terms, acute inflammation may be described as a disturbance
of the machinery destined for the maintenance and repair of the part
in which it occurs, accompanied necessarily with disorder pervading the
blood and vascular system. And tliis addition is to be made (of the great-
est moment when an organ essential to life, as the lung or liver, is the seat
of the disease), namel}', the interruption of the function belonging in the
animal economy to the organ concerned. For if such an interruption be
not speedily relieved, great and too often. fatal disturbance in the offices of
life will be the inevitable consequence.
The good effects of the received treatment in acute inflammations are
established by such an infinite number of proofs, that one wonders how
any doubt can arise even among the most negligent observers. The im-
mediate relief, for instance, in pleurisy, to the pain, the cough, the diffi-
culty of breathing, and the whole febrile uneasiness, by blood-letting, is
conclusive as to the suitableness of the treatment of which that is the basis.
And this — the fruit of experience, in a subject of observation free from any
embarrassing complication — is in exact accordance with the inference by
reasoning from one or two simple principles of the most general application
to living action. In a disease of the highest excitement, like an unem-
barrassed acute inflammation, all that is known of living action enforces the
necessity of a diminution of that excitement by every means already ascer-
tained to be compatible, under such circumstances, with the continuance of
life and with after-health. It is equally true in inanimate machinery
and in the living frame, that any sudden alteration of the proper fisibric
puts an end to action. But the great source of sudden alteration in the
texture of living parts is acute inflammation. The greater the excitement
the greater in general is the tendency to alteration. And the suddenness
of any change is seen to operate far more effectively towards a fatal event
than the same amount of change more slowly produced.
With such indisputable results before us of experience and Inference, we
cannot but resist being persuaded by any limited induction of apparent
facts, and still less by the pseudo-inductions of knavery or folly, that any
remedies can subdue acute inflammation, as is taught in homoeopathy and
hydropathy, and in not a few other less noted methods of quackery, with-
out being of a kind to diminish excitement.
From the unavoidable imperfections of nomenclature, there must often be
included under the same name cases of so trivial a nature as hardly to re*
quire treatment, and cases of the most hazardous complexion. Inflamma-
tion of the lungs, inflammation of the liver, pleurisy, and the corresponding
technical names, are terms which fail to express whether the excitement be
so slight that it may be safely left to nature, or so violent that, if unabated
by art, it must put an end to life in a short number of hours. It is
easy to see how favourable such a state of things is to the pretensions of
quackery.
The infinitesimal doses of certain drugs — for example, of phosphorus-
relied on by homoeopathists for the cure of inflammations, are such, we
understand, that the bulk of each, as compared with the mass of the human
body to be acted on, is but faintly imaged by the difference between a
particle of sand and the magnitude of the earth. When an inflammation
subsides under the application of the hydropathic wet sheet, or the use of
a dose of phosphorus so disproportionate to the alleged effect, however
appalling the name given to the disease maybe, the legitimate explanation is,
that it was one of those inflammations in which the excitement and tendency
QUACKERY IN DISEASES, 385
todepravation of organic structure is so small that little treatment is necessary.
In the bulk of acute inflammations the well-known empiricism of Sangrado,
though far from being uniformly free from hazard, is on the whole safer
than any other kind of empiricism. That empiricism is only not safe
because acute inflammation, though less liable to variation of character than
other diseases and groups of diseases, deviates in some seasons, and in all
seasons in some individuals, so far from itself, that the judgment of the
practitioner is called on for a new rule of practice — for a rule different from
that which applies to ordinary cases.
Acute inflammation is never safely left to a spontaneous termination,
except when of a faint shade, and other circumstances are favourable to the
regulated exercise of the self-healing power of nature. All unbiassed ex-
perience attests the danger of leaving inflammations of internal parts to
themselves, or to inefficient treatment. It is not the speedy occurrence of
death that is the sign of such an error ; for under the appearance of a
favourable termination the seeds of new diseases may be originating that
are to extinguish life at the end of months or years. Without treatment,
or under nominal treatment, like that of homoeopathy, many inflammations
will subside without being subdued, leaving behind them alterations of
organic fabric, the first commencement of protracted and ultimately fatal ill
health. Finally, in acute inflammations, death is far more frequently due
to sins of omission than to sins of commission. And sins of omission are
the faults chargeable against most kinds of quackery, and against most of
those practitioners whose vanity leads them to flatter themselves that a
small experience within a limited circle, and that probably many times
resting on pseudo-observation, should outweigh the convictions of the pro-
fession at large, founded on the experience of ages. No kind of quackery
can bear to be tried by the ultimate result of inflammatory diseases, when
the exact history of any considerable number of the alleged cures can be
traced onwards for several years.
But all inflammations are not of the character we have been insisting
on. And certain chronic inflammations, as well as some other chronic
diseases, under a new point of view, will illustrate the difficulty of judging,
without adequate knowledge, in the questions at issue between quackery
and regular medicine. Many such diseases are cured by time — that is, by
the power of recovery inherent in the constitution, as soon as obstacles be-
fore existing to the exercise of this power have lost their previous force.
Of this description are some slow inflammations of organs not altogether
essential to life — ^for example, chronic rheumatism, inflammations of the
periosteum, that is, of the membrane investing the bones, inflammations of
the bones themselves, and of the textures entering into the joints. Such
diseases are particularly apt to arise along with various forms of slow
derangement of health, that is, some one of them is often present in addition
to a chronic state of ill health. And unless it be possible to amend the
general health, these inflammations often prove refractory under all modes
of treatment. If that amendment has once begun, as often happens from
unobserved causes, the first remedy that happens subsequently to be used
carries off undeservedly the credit of the cure. A familiar example will
make this intelligible. A patient resorts to a watering-place, leaving off^
for a time some harassing employment, when a signal improvement of
general health follows. Then the local disease, which probably for years
has proved the source of annoyance and disquietude, yields at last. On
how slender evidence, then, does the medical practitioner or the quack-
3c
S86 LAST OF GROSS POPULAR DELUSIONS —
doctor of the place, as the case may be, obtain in the eye of the public the
praise of a cure, to the discredit perhaps of the original medical attendant,
whose remedies wonld hardly have fs^ed of effect with the same allowance
of time, and with the same relief from the anxieties of business !
Among the chronic maladies, besides, which time has the chief hand in
curing, are many injuries of joints, the profitable field of the boastful bone-
doctor, and not a few disordered states of secretion. These last arise under
multifbrm circumstances, but under none oflener than at critical periods of
life. The cure is genendly slow and imperceptible, and often much pro-
moted by unobserved alterations in the mode of life, and by the unnoticed
growth of various new relations of health. And it is too often the lot of
the medical man, who by skilful treatment, during the most critical period,
has preserved unbroken the strength necessary for the natural cure, to be
blamed for the tediousness of the disease. Here again fortune fiivoura the
quack-doctor, who steps in at a happy moment, and reaps all the credit of
a cure which took place in spite of his nostrums.
Lastly, among the chronic disorders which illustrate the view taken in
regular medicine of the nature of diseases and treatment, are many complex
forms of nervous derangement or perversions of the nervous power. These
time often cures. For in the onward progress of life the whole energy of
health sometimes improves, or the entire character of the constitution
alters, or else slow inflammatory action, by which irritation has been kept
up, subsides, or other sources of irritation gradually lose their force. When,
in cases of this kind, loss of motion is the chief symptom, the disease may
have become cured for some time before the person is aware of it. For
having become habituated to the motionless state of the affected part, he
may make no effort to move it for months or years after the ability to move
it has returned. In such a case, whatever first calls forth the successful
effort cannot fail to carry off the praise of a cure. The view here taken
explains a multitude of difficulties.
Dr Abercrombie cites the case of a man, who, when his house caught fire,
recovered the long- lost use of his legs. And the so-called dumb son of
Croesus, who regained his voice in time to save his father^s life in battle, is
probably another instance of the same description. In this last case, how-
ever, we assume that the ancient historians have confounded, as might
easily happen, the loss of voice with dumbness or loss of articulate
speech ; when a person has lost his voice, he still retains the power of
speech, but he ^)eaks in a whisper. The lost voice is sometimes suddenly
restored by a smart shock of electricity, which may be supposed to act
much in the same way as the emotion of sudden fear for his father's life on
the son of the King of Lydia. If the young man was really dumb, this
explanation is hardly applicable. There is, however, a story which some
of our readers may remember, in Boz's life of Grimaldi, whidi, if not alto-
gether apocryphal, would show that even dumbness may be recovered from
under like circumstances. The hero of the tale is a sailor, who, after hav-
ing been deaf and dumb for several years, suddenly recovered his hearing
and speech under the excitement produced by Grimaldi*s grimaces.
From the sketch just given, we trust it has appeared to the satisfaction
of our readers, that the sources of fidlacy in the judgments of the public on
points of medicine, are more numerous than could at first sight be suspected ;
that there are many diseases which give so plausible a colour to the preten-
sions, however unfounded, of charlatan practitionei's, as cannot but deceive the
unwary ; and that there is a long catalogue of prevailing maladies, in which
QUACKERY IN DISEASES. 387
to rely on their boastful promises is to trifle in tlie most hazardous man*
ner with the sacredness of human life.
To decrj regular medicine, and to heap abuse on its best established
usages, is characteristic of all modes and forms of quackeiy. Let us con-
sider for a few moments how £i,r such abuse is well deserved.
In medicine there has been much absurdity, as one might expect in a
profession which has existed among recorded sciences for more than two
thousand years. But is medicine in this fespect more censurable than
other sciences which had an early date ! It would be easy to show that no
department of knowledge has kept itself more free from the absurdities of
ignorant ages than regular medicine. We shall not surely be required to
enrol in the regular profession of medicine every pretender, throughout
past ages, to the cure of the diseases. Thus, for any one at present to place
Hahnemann among the worthies of medicine, side by side w^th Hippocrates,
would be indeed to beg a question whicli surely at the least is still un-
settled. The medicine taught in the works of Hippocrates, nearly as far as
it goes, is the strictly regular medicine of our day. The dogmas of Hahne-
mann are entirely at. variance with the medicine of Hippocrates. If the
name of Hahnemann survive to after ages, Hippocrates must sink into in-
significance. There are no doubt points in common ; but the points of
agreement are trivial compared wi^ the points of difference. The end of
all medical science is the cure of diseases. If there be no two points in com-
mon between the treatment of Hippocrates and the treatment of Hahne-
mann, their respective systems must be pronounced to be radically different,
to have no pretensions to come of a common stock. The treatment made
known to us by Hippocrates was founded on experience, and in its most
essential points has been confirmed by the almost universal testimony o£
the profession down to our time. The treatment of Hahnemann professes
to rest likewise on experience. But his experience is not the experience
of the age of Hippocrates, and of the medical profession downwards. It
is an experience peculiarly his own. Hahnemann cannot be said to belong
to the medical profession otherwise than as having held a medical diploma.
And this surely is no title at all in one who rejects the essential basis of
the profession, and declares the sum of its experience through more than
two thousand years to be a He. If it be said that Hahnemann did belong
to the medical profession because he received the usual education of a
medical man, we would pronounce it to be as valid to say that a medical
man, who after the completion of his education becomes mad, is a sound
practitioner.
It may be conceived that he aimed at introducing no greater innovation
into medicine than Stahl, Hoffmann, Boerhaave, or Cullen. They
were severally the founders of systems ; but the difference is^ that their
systems were not opposed to the medicine of Hippocrates taken as a type of
the profession, but embraced it. And here we discover an exact test by
which to ascertain whether the founder of a new system belong or not in
strictness to the medical profession. There is a broad distinction between
that kind of innovation which adds to a department of knowledge, or
remodels the facts before accumulated under such or such a head, and that
opposite kind of innovation which pronounces what had been before recog-
nised as a branch of science, to have been a pseudo-science, composed merely
of so-called facts, connected together by misapprehensions under the disguise
of principles. If any man can be termed the founder of a system, surely
Newton is entitled to that honour. Yet the idea of universal gravitatio»
388 LAST OF GROSS POPULAR DELUSIONS —
arose in his mind without the addition of one new fact to those before
accumulated in physical science. His discovery did not contradict, but
confirmed the knowledge already stored up in astronomy and the allied
physical subjects, by showing that a fixed order and reciprocal dependence
existed among the facts before ascertained.
Regular medicine, then, owns its descent from the school of Hippocrates.
It is in effect Hippocratic medicine augmented, improved, and polished by
the lights of succeeding ages. And all innovations which reject the
essential basis of this school must be included under the name of non-
Hippocratic. The absurdities commonly thought to disfigure the annals
of medicine, in which we firmly believe Hahnemannism will one day be
placed, belong chiefly to the non -Hippocratic division. And, therefore,
regular medicine is not to be cliarged with the anilities which occur in the
history of mankind in regard to the alleged means of curing diseases.
There cannot be a stronger evidence of the foundation of the Hippocra-
tic medicine being fixed essentially on fiicts open to observation in all ages,
than its endurance through so many generations, amidst the wreck of all
kinds of systems, and without the continuance of any blind veneration
for the name or for the works of this author.
One system blots out the memory of another ; Stahl is overthrown by
Hoffmann, Boerhaave by Cullen. Yet in such successive contests the
vanquished and the victors for the time equally bow with reverence to the
symbols of regular practice as represented in Hippocratic medicine.
When, then, we set aside the men whose conduct and opinions exclude
them from the regular profession, the disagreements among medical men,
of which so much is made in all attacks on the profession by interested
parties, though still we admit too great, become trivial as compared with
the numerous points on which all are agreed. It would be surprising if
there were not considerable disagreements ; nay, were there not disagree-
ments, the public would have reason to suspect the sincerity of the profes-
sion in general. For that profession is composed of a large body of men,
not for the most part calm philosophers, but persons engaged in the actual
business of life, struggling with rivals for superiority, and withdrawn in
the mass from the simple contemplation of physiological truth by the
necessity for accommodating themselves in some degree to the wayward-
ness of the public mind. Some among so many so situated cannot always
be restrained by the example of their more sensible brethren from striving
to render themselves singular by the novelty or peculiarity of their views,
or to place themselves apart from the common herd by the eccentricity of
their opinions, while perhaps tliey still keep within the bounds of Hippo-
cratic medicine. This conduct, we grant, is excusable only when kept
within the narrowest Hmits. But the public stiH give to less scrupulous
men more than enough of encouragement to parade before them the
points on which they differ from their brethren and the advantageous
peculiarities of their own practice. Nor would the public err, if, remem*
bering that they cannot be the fit umpires in debated points regarding the
treatment of diseases, they looked on every medical man who makes a
merit to them of the differences between himself and his brethren as in
the equivocal position of one wha would enjoy the monopoly without the
shame of a quack-doctor.
To differ from his brethren, and to make the most of that difference to
enhance his own reputation with the unthinking, to blame their treatment
as often as a safe opportunity offers, to listen with the broadest marks of
surprise to the patient*d account' of the remedies he has been put through
QUACKERY IN DISEASES. 389
by other practitioners, and, while he inwardly chuckles at the rising cre-
dulity of his dupe, to hold up his hands and wonder that he is alive, are
not newly discovered arts, but in all ages the vulgar expedients of low
cunning. Such despicable manoeuvres are now, it is to be hoped, on the
decline ; but for their existence at all the public are to blame, since without
their countenance no motive would exist for such conduct.
What is all that to the purpose ? — cries some new stage-doctor disguised
in a few tag-rags of science. Is not your Hippocratic medicine the source
of an imperfect art ! Does it not often fail to accomplish its objects ! Why
should it be impossible, by a discovery as sudden as Harvey's or Newton's,
and such as I have made, to place medicine on the footing of an exact
science ! And many, doubtless, will re-echo — ^Why !
The first thing that strikes us here, is the oddness of the choice almost
uniformly made of the person who is to put shame on the honoured brows
of such men as Sydenham, Boerhaave, Hoffmann, CuUen, Hunter — as if
something like the Mahometan reverence for idioms, as favoured of Heaven,
had taken root in Chi*istian lands ; — witness the house-painter of Limerick,
the clodhopper of Gr^fenberg.
But what kind of certainty is desired for medicine ! Is there any one
so short-sighted as not to see that a close limit is drawn around the power
of medicine by the visible liand of the All- wise Ruler of created things !
In ilie economy of nature there is assigned to medicine a comparatively
narrow province. Is it desired that medicine should be of such certainty,
that the death of age should be exchanged for an indefinite renewal of youth \
Some such ideas Condorcet insinuated even when the guillotine hung over
his head, but our age hardly admits such follies to a pot-house hearing. But
the maligners of Hippocratic medicine would perhaps be content could its
power make men live, if not unaffected with disease, safe at least from its
fiital effects, up to the alleged age of Parr or Jenkins !
Next, what is the improvement in certainty expected from surgery in the
effects of accidents ! Nothing less, we suppose, than shall suffice to put an
end to the very name of mortal wounds in the field of battle — restraining
the effects of the now destructive engines of modem warfare to wounds
curable within a few days by some Promethean process, the discovery of
which is reserved for some still unborn Preisnitz or Hahnemann in the
department of surgery.
It would be easy to point out the boundaries within which, by the visible
ordinances of living nature, the advance of surgery must be circumscribed.
But by what steps has surgery so far proceeded towards its appointed limits !
— ^not surely by the discovery of special remedies such as quackery delights
in ; but by the unwearied study of the process by which wounds heal under
the direction of nature, and by vigilance to remark the incidental circum-
stances which in each case may have forwarded or retarded the efforts of
the self-healing power. For surgery owes all its undisputed modem supe-
riority, not to the sudden discoveries of individual surgeons favoured by
fortune, but to the slow growth of physiological knowledge— of the know-
ledge which explains the essential laws of the animal economy. Each
advance in such knowledge gives to the scientific surgeon the power to
penetrate farther by observation into the before-hidden acts by which the
process of healing is forwarded or retarded. And the same remark may be
made of the study of organic nature in general, whether in health or dis-
ease. . No acuteness of sense — ^no assiduity of attention — can make a suc-
cessful observer in organic nature, without a previous knowledge of some
390 LAST OF GROSS POPULAR DELUSIONS
part of its laws. The honest witness in behalf of quackery, ignorant of the
&llacies springing from this source, is imposed upon at every step by what
he sincerely believes to be the evidence of his senses.
To any one, then, who considers the subject rationaUy and calmly, without
foi^ttiug the indisputable conditions on which man exists upon earth, or
the known relations between him and the rest of nature, the whole of our
present medicine, both as an art and as a science, when tried by the state of
our advancement in other parts of complex knowledge, will at once appear
to be just what a person of judgment and well-informed mind would expect
it to be. It is not, indeed, a peifect science, nor capable, as an art, oi pre-
venting the approaches of death under all circumstances ; yet fit to afibrd
the means to those who will act on its precepts, of attaining a greatly
increased average value of life, — to give protection against much of the
suffering naturally inseparable from diseases, and, what is often its chief
use, to provide a guard against the aggravation of the danger and the una-
voidable ills of sickness by the rashness of officious meddlers in the sick-
chamber. Such meddleiS are hardly a less evil than quack-doctors. Veiy
well-meaning people no doubt they are. But they forget how dangerous
the little knowledge universally is ; and, trusting to the chapter of accidents
for success,, often persuade the patient, to the great hazard of his life, to try
their little nostrums in preference to the precepts resting on the past experi-
ence of the profession from before the time of Hippocrates to our own.
Medical men commit errors sometimes, and these errors doubtless are
occasionally of fatal consequence. But what profession among men is ex-
empt from the like misfortune ! Does any one propose to himself to intrust
his affairs to some Ignorant bragging pettifogger because solicitors of emin-
ence have made mistakes ! Or, would any one advise the world to employ
pretended engmeers, pretended shipwrights, or pretended builders, on our
bridges, our ships, or our houses, because mistakes even afiecting human
life have been brought home to regulariy-trained members of these occu-
pations !
When the medical profession, as a body, discover a usage to have proved
injurious, it is at once discontinued ; when a medical practitioner sees that
he has used a remedy under inappropriate circumstfuices, he avoids that
error in future. Thus every mistake in regular medicine becomes the
means either of general or of individual improvement. But quackeiy is
committed to pursue one line of practice *^ nulla vestigia retrorsum ;" the
show of efficacy in the boasted nostrum or string of nostrums must be main-
tained at any cost of human life.
It may be replied to our argument, that much of what has been said is
true as respects common quackery, but that homoeopathy should be made an
exception, inasmuch as, while its supporters are men of character and edu-
cation, it acknowledges the diagnostics of diseases and shades of diseases, the
usefulness of pathology, and rejects merely the remedies of the established
school, for which it substitutes others resting on the authority of observation.
We admit at once that homoeopathy is an idolatry *^ majorum gentium ;"
that it is calculated to impose on minds of higher calibre than those of the
little vulgar who were the victims of Dr Solomon and Mr Lignum. Nay,
we will allow that it far outvies in ingenuity the petty contrivances of
Morrison, St John Long, and Preisnitz. In fine, we will declare, that the
system is so subtile as to hoodwink, not the patients merely, but the prac-
titioners themselves, as soon as they have learned to prescribe by the rules
for the production of an infinite series. We pronounce homoeopathy, if not
QUACKERY IX DISEASES. 391
actual quacker jy at best closely akin to quackery. Unequivocal marks of
its consanguinity with quackery discover themselves at every step, notwith-
standing the disguise of science which it assumes. The professors of homoeo-
pathy may be, as a body, guiltless of the knavery with which quackery is
for the most part chargeable. The honesty of witnesses is no sufficient
security against deception. Accordingly, with all the knavery that belongs
to quackery, there is in the world no small proportion of honest quackery.
Nor can we doubt that a great number of homoeopathic practitioners impose
upon their patients only because they themselves are first the victims of
self-deception.
It needs no very extensive knowledge of mankind to obtain the conviction
that there are in the world a good many persons, otherwise even of shining
talents, who have not the gifts of plain sense and sober judgment. Now,
without these gifts, the experience of all ages shows that no pains of ob-
servation can give wisdom — that without them even the soundest rules of
philosophy lead but to absurdity. But if there be any one subject pro-
fessing to rest on the rules of induction, in which there is unusual difficulty,
and therefore standing in particular need of the aid of those gifts, that
subject is the determination and verification of medical fact« as respects the
effect of remedies on diseases. Nothing but time and a host of observera of
tried sense, judgment, and good faith, can overcome the difficulty. In this
respect the pretensions of homoeopathy, as compared with regular medicine,
are ridiculous in the extreme.
We cannot take the time at present to enter on any searching examina-
tion of their so-called observations. This we may attempt on another
occasion. But we should like our readers to hear their answer to this
question, — ^Why the observations of Hahnemann and his followers, made
within a short time and by persons of no recognised character for good faith,
should be held to set at nought the accumulated and oft-corrected experi-
ence of past ages ! The answer to this question volunteered at once by the
whole sect, exhibits the system erobla?:oned with the unequivocal ensigns
of quackery — for it amounts to this, the exclusive credibility of their expert-
mentSy the exclusive virtue of their remedies, their exclusive title to make use of
kroad assertion in lieu of proof These we regard as the infallible signs of
quackery ; and those, we think, who hesitate to bestow on their system the
title of quackery, will have no alternative but to deny the significance of
these signs ; for it is impossible to mamtaln that these signs are not every
where stamped upon their works,
Dr Wood sums up his remarks on their experiments in the following
" But when we come to examine these experiments, they are incapable
of establishing even probable truth, much less statements so marvellous
as those of homoeopathy. Whichever way we tum, on whatever side we
look, we still encounter disappointment. That such a system should liave
its professors is not wonderful, when the credulity of man offers so tempt-
ing a bait. That such absurdities should have their admirers, will not sur-
prise those who have studied human nature in its various and more painful
phases. That such a practice should boast of cures, is no novelty in the
history of empiricism. The same sources of fallacy may be again and
again taken advantage of by each new adventurer in this field ; and, when
homoeopathy shall have passed away, it will only be to make room for
some new mental epidemic — to be a new nine days* wonder, and then
expire." — Homoeopathy Unmasked, pp. 142, 143.
392 LAST OF GROSS POPULAR DELUSIONS
From the " Defence of Hahnemann and his Doctrines" we extract the fol-
lowing passage, at the risk of giving a new lesson to the Solomons and
Lignums of the newspapers : — _
'* The greater part of the emoluments of medical men of the old school
arises from the imperfections of their practice. Whether they have the
wisdom, as many, especially the more experienced of them, profess, to * do
very little, and let nature take her own way ;' or, with the impatience of
youth and inexpeiience, deal pill and potion right and left, cut, hurn, hlister,
hleed, and purge, in abundant penny woHh for their fee, their'patients lie long
on their hands for the most part, and the attendance is profitable in propor-
tion. Again, the utter incompetency of the means they use to cure a mul-
titude of chronic ailments, so far fh)m being an evil to them, is a great
and universal benefit ; for the unhappy persons on whom they practise,
failing to find relief from one, hie to another of the same trade ; and thus
from year to year make the dismal round, spending, it may be, all their
substance on physicians, like the woman of old. Homoeopathy, by curing
recent diseases more promptly, and, besides curing more certainly, demand-
ing less frequent visits to those labouring under the more protracted, just
because the operation of its medicines does not need to be so suspected and
watched, as is notorious in the case of the Allopathic drugs,— cannot &il
to make deep inroads into professional incomes, and to lessen very much
the number of practitioners that shall be needed to meet the altered circum-
stances of the public. Then, as to the apothecaries, they, of all persons
connected with the profession, have the most reason to dread the general
adoption of homoeopathy ; whether, as in Scotland, they subsist by merely
vending drugs ; or, as is the case in England, are, at the same time, prac-
titioners, who are paid by the quantity of medicine which their employers
swallow. The reader will perceive w^hat sort of motives these * practitioners
of virtue ' have for their opposition to homoeopathy ; and, if there are
some whose disinclination to examine the improved system we cannot
fairly ascribe to such sources, we shall not be far wrong in suspecting that
nine-tenths of them owe their reluctance to a dislike of innovations which
would overturn the system with which all their own labours are identified,
and necessitates the relinquishing of dogmata and methods by which they
have been accustomed to be guided, for elementary studies and a new
experience, not to be acquired without much application and fatigue, both
of body and mind." Pp. 22, 23.
From Dr Wood's Reply we take the following summary of hom(eopathig
FACTS for the amusement of our readers. Dr W. copies them verbatim
from Laurie's translation of " Jahr's Manual," which is an abridgment of
Hahnemann's " Materia Medica Pura."
"'Common salt* produces * awkwardness — incapacity for reflection —
anguish, sometimes during a storm, but especially at night — ^numbness and
insensibility on one side of the nose — repugnance to tobacco smoke — ^para-
lytic weakness of the legs — corns on the feet and warts on the hands —
hatred to persons from whom offence has formerly been received,' &c.
" * Nutmeg' produces * bloody sweat and epilepsy.'
" * Agaricus ' produces * an inclination to make verses and prophcsj''.*
"*Tea' produces *a sensation of hunger and a dislike to all food, and
great relaxation of the stomach, which hangs down like an empty purse.'
" The * South Pole of the Magnet ' produces * dislike to society and
laughing faces,' and * causes the toe nails to penetrate the flesh.'
*' The * Sweet Violet ' causes * one to lie on the back, while asleep at night,
QUACKERY IN DISEASES. 393
iptrith the left hand passed under the head, and the knees bent ;' and also
produces * great flow of unsettled and conftised ideas,' and * remarkable
tflearnesB and great activity of mind.'
** * Mephitis Putorius, the fetid juice of the polar pole-cat,' renders * wash-
ing with cold water very agreeable.'* And so with the rest.
" We find, too, that these meti — some of whom attained a good old age,
and were esteemed healthy and sane by their fi-iends— experimented on
themselves with substances which arfe said to produce, when taken by a
healthy person, * attacks of Tetanus and Lock-jaw,' 'Caries and painful
ulcers, which attack the bones and perforate them to the marrow ;' as
Angustura.
** * Protrusion and incarceration of inguinal hernia ;' as Alumina.
** * Inflammation of the tendons ;* as Antimony.
** * Loss of memory, with diminution of the intellectual powers ;' as
Ammonium.
** * An irresistible desire to blaspheme and to swear ;' as Anacardium —
the Cashew Nut.
** Perhaps the * Defence of Hahnemann * was written under the influ-
ence of Granatum, which produces * arrogance ;' — or Belladonna, which
causes * a desire to bark and bite ;'— -or Ignatia, from which flows * effron-
tery ;* — or Anacardium, which stimulates to * insults, invectives, and out-
rages ;' — or perhaps the indecency which appears in some homoeopathic
works, arises from Belladonna, which produces * immodesty.' We presume
it is for the purpose oi proving y beyond a doubt, that the symptoms alleged
to have been produced are actually the result of the remedies, that we are told
that Cayenne Pepper causes * pain in the roots of the hair after scratching;*
that Animal Charcoal produces * pain and blistering of the seat after riding;^
that Berberis produces * sensibility of the eyes to the brightness of the sun ;*
that Nutmeg causes * shocks of pain in the teeth, after having drunk cold
water ;' that Sulphuret of Lime causes * cough after drinking,' &c.
" When they tell us of their wonderful cures of physical diseases, of which
the public know nothing, we refer our readers to their pretended power over
moral disease^ of which they can, in so far, judge. They will find that Di-
gitalis is recommended as a homoeopathic cure for Sadness ; that those suf-
'fering from * Anguish,* — ^if it occurs in the * open air,' are to take * Bark ;*
— if * in a carriage,' * Borax.' Should they be assailed * in the morning,'
let them take — * Arsenic ;* if * in the evening,' — ^ Ambra.'
" * Awkwardness' is now to be cured by * Anacardium,' and * embarrass-
xnent in society' by * Ambra ;' while ' a child who oannot bear to be looked
at,' is to be treated with « Antimonium.'
" Fear, too, has its appropriate remedies. Is it of * contagious diseases !'
it is to be cured by * Baryta ;' is it of * misfortunes V by * Calcarea ;' is it * of
robbers V — * Arsenic ;' is it * of spectres !' — ^ Aconite ;* is it * of solitude V —
* Lycopodium ;* is it * of dogs V — * Bark ;' is it • at night V — * Lamp-black ;*
is it in * the evening V — * Ivory Black.'
* <' The propriety of this symptom will be obvious from the following description,
from Cuviet's * Animal Kingdom.*
<< ' The intensity of their most nauseous suffocating stench, which has been de-
scribed as resembling that of the Fitchet, mingled with assafoetida, is scarcely cre-
dible.' * It will comfort homoeopathic patients to find one of their eminent
authors asserting, that < their remedies are in almost all cases destitute of sensible
properties, such as colour, taste, or tmelV ' — {HomcBopathic Journal y vcl. i. p. 22.)
The efficacy of trituration must indeed be wonderful !"
3d
394 LAST OF GROSS POPULAR DELUSIONS —
^ But if fear becomes * despair/ new remedies are at hand. Is it a ^ De-
spair of being cored V let the patient take * Bryonia ;'* * Hardness of heart*
finds its appropriate remedy in ' Anacardiam/ which is also recommended
for * Impiety ;' while ^ Despair of one's eternal salvation ' is to be treated by
* Lycopodium.'
*' A * Disposition to make mistakes ' is to be remedied — if * when calcu-
lating/ by * Ammonium Carbonicum ;' if when 'speaking/ by * Alumina ;'
if * about weights and measures/ by * Nux Vomica / if * when writing/ by
* Bovista.' " — Sequel to Honueopathy Unmasked, p. 4*7.
To enter into a particular detail of the respective characters of the works
before us, is foreign to our present purpose. Dr Wood has performed the
task which he has imposed on himself with much ability. The answer
contained in the ** Defence of Hahnemann and his Doctrines,*' &c., is an
able but unscrupulous performance. The author or authors of the ^ De-
fence/' secure in their anonymous position, have felt no necessity for re-
straint in the abuse of their antagonist, and little, we are compelled to say,
in the misrepresentation of lus statements. Dr Wood's reply, the third
work on our list, exhibits the defenders in £Eir from an enviable light.
In *' Homceopathy Unmasked/' the author enters upon the subject from
the bottom. At the outset he offers some general considerations applicable
to Hahnemann's so-called universal law, ** similia similibus curantur." He
shows successfully that a general law of the character which it afiects is
inapplicable to medicine. He then points out the want of definite signifi-
cation in the word ^ similia," used in the expression of the law ; and finally
proves that, in whatever sense " similia" is taken, the law is not universal,
even according to the homceopathic interpretation.
By comparing the several recognised kinds -of evidence with that put
forward in behalf of this so-called law, he shows it conclusively to be an
assumption* not supported by &cts, but resting on assertions ; and, further,
that even the conversion of those assertions into facts would fiul to establish
it as a law. He then enters upon a review of the inconsistencies of the
whole scheme of homceopathy— -of the frequent deviations of its professors
from the rules laid down by themselves as unalterable — of the absurdities
and contradictions of the infinitesimal-dose system — and, finally, of the
total deficiency in their witnesses of the qualities requisite to make testi-
mony available.
In an appendix, we find numerous cases illustrative of the fiital conse-
quences of trusting to homoeopathic. treatment in acute diseases— of the
practice of the homceopathists to dress up slight maladies in formidable
names — ^and of the facility with which quackery in general succeeds in
producing an imposing array of apparent cures.
Our readers will see that Dr Wood has spared :no pains to probe this
matter to the bottom ; and if they are desirous to witness the operation of
the machinery behind the homceopathic curtain, we recommend to them a
perusal of his book.
No doubt, when they take up the anonymous defence, they will feel
some misgivings as to Dr Wood's knowledge, ability, and good faith ; but a
• " Bryony is a long. established favourite among charlatans. Miller says, * Moun-
tebanks carry about fictitious images, shaped from the roote of bryony and other
plants, cut into form, or forced to grow through moulds of earthen ware, as man-
drake roots. These they sell to silly women under the pretext that by their
potency,' &c &c."
QUACKERY IN DISEASES.
' very slight glance at his reply in the ** Sequel to Homceopathy Unmasked,'*
and particularly at the appendix, will satisfy every one that Dr Wood is
deficient in none of those qualities, and that the defenders, in too many
I instances, have sought to screen homceopathy by stabbing in the dark.
' The cleverness of the defence lies in the skilful choice of a few ^^ ad cap-
I tandum" topics, which are worked up with little regard to truth, in a man-
ner well fitted to impose on non-professional persons.
As a specimen of bold assertion, we would direct attention to the match-
less attempt to draw a parallel between the opposition offered by an insigni-
ficant handful of unknown medical practitioners for a short time to Jenner's
discovery, and that given for so many years by the profession at large to the
ravings of Hahnemann. On this subject Dr Wood's observations, in the
** Sequel to Homoeopathy Unmasked," will be found highly interesting.
We have not left ourselves room to make any remark on the fourth book on
our list — Sir Charles Scudamore's Account of Hydropathy. We will merely
say, that if Sir Charles' patronage of this new quackery gain him some
additional weight with the credulous part of the public, it cannot but im-
pair the well-merited reputation which he once held in his own profession.
If any of our readers, in opposition to the views taken in this article, still
feel compelled to dwell on what they regard as cases of cure within their
own experience, under homoeopathic or any other kind of quackish treat-
ment, we beg leave to remind them, that they can never have known an
honest believer in ghosts or in witchcraft who had not abundance of
strongly-witnessed affirmations in the shape of positive facts to produce
from his budget ; — again, that none of the delusions referred to at the out-
set of this review were unsupported in their day by numerous attestations
and a multitude of apparent facts ; and, lastly, that we do not call upon
them to believe that their friend M. or N. was not at a certain time afiPected
with a particular disease (the name of a particular disease being at least given
to his complaint) — that he did not waste ten or twenty days in taking as
much phosphorus as amounts in all to a small fraction of the quantity which
must enter every man's frame as often as he lights his candle with a
Congreve match — and that, at the end of a certain number of weeks, he
was not freed from disease. All this we admit to have taken place ; but
we deny the connexion between the recovery and the use of the particular
remedy. We say that he would have recovered equally well under the
use of bread piUs, provided in the mean time he had been kept safe from
hurtful agencies ; and, it may be, provided some legend had been con-
nected with the pills. But while we deny the connexion between the cure
and the use of a particular homoeopathic remedy, it may be seen that we
are far from affirming that the patient would in every case recover as well
under no treatment at all as under homoeopathic treatment. The danger
of homoeopathy lies in the neglect of active remedies in acute disease — in
the refusal to moderate the actions of the body, which are fitted to restore
health when duly regulated, but which destroy life when allowed to be-
come over-excited. In some chronic diseases, homoeopathy may have an
effect not superior to that of judicious regular practice, yet beneficial as
compared with no treatment at all. Any direct curative effect in their
infinitesimal doses we must positively disbelieve ; yet the daily adminis-
tration of remedies free from noxious effects upholds the moral treatment*
And it i^ould be confessed, that some of the remedies which enter into the
alterative treatment of regular practice most probably have no other opera-
tion than that of seconding the moral treatment of chronic diseases.
396 . LAST OF GROSS POPULAR DELUSIONS —
Doubtless, the good e£Fectfi of homoeopathy are produced almost ex-
clusirely by regimen and the moral results of treatment. Of the powerful
aid of regimen the homceopathists know well how to avail themselves.
Regimen and moral treatment accomplish all or nearly all that homoeopathy
is capable of. Their infinitesimal doses hare aboat as little to do with the
recoveries that take place, as St Swithin has with the rain that is now
falling in torrents as we write. On the subject of regimen our reader?
need no explanation. Of what we mean by moral treatment we must try
before concluding to give a faint idea.
There are few men and fewer women so independent of their fdlpwr
creatures as not to feel some alleviation of the burden of suffering, whether
bodily or mental, by the sympathy and support of those around them.
Now, there are numerous chronic diseases which create painful apprehen-
sions, to some degree in the minds of all, and in a high degree in those
who are very dependent on the support of others for the i^iare of fortitude
which they can call forth. If such diseases be curable, as nothing aggravates
them more than despondency and downcast spirits^ so nothing tends more
to a speedy cure than cheerfulness and hope. Moral treatment, then, as
far as is required for our present purpose, may be described as including
all the measures by which such a temper of mind can be produced and
maintained. The mere administration of drugs in which the patient has
confidence is a part of the moral treatment. But the most effectual part
of the moral treatment consists in the frequent visits of a medical attendant
in whom the patient reposes trust. Each visit serves to quiet some new ap*
prehension, and brings a fresh assurance of the curable nature of the disease.
Hear the late Dr Cheyne on this subject : — ** We may be permitted to
state, in support of this observation, a fiict which we have often witnessed,
namely, the temporary advantage which is generally derived from a change
of measures. When an epileptic patient is placed under the care of a con-
fident empiric, or of a physician v^ is in great repute, the disease will
often be suspended for a considerable time, and to the eye of a sanguine
person appear cured ; while on the other hand, after a long suspension,
when the disease returns, such disappointment is produced as to fill the
patient with the gloom of despair, a state of mind which would seem to
renew the energy of those causes upon which the fits depend, and hence
they occur at shorter intervals and with greater violence tiian ever.
*' The empiric, well knowing how much depends on confidence, has various
methods of fixing unstable minds : . he cajoles and blusters, and with equal
power of fulfilment he promises and threatens : he knows that he may draw
upon the imagination o( his patient to any amount, and that his draft will
be honoured ; that the mystery with which he clothes all his measures is
often the cause of his success ; and hence he provides his own remedies,
and invests them with supposititious activity. Qive a patient a few grains
of liquorice-powder, and let him be told that he has just swallowed pot of
the skull of a malefiictor (which once was considered a sovereign remedy
for epilepsy), or that this powder contains a substance of which, according
to the Grennan dreamer, a thousandth part of a grain is the proper dose, and
you often may thus cure a disease which is anything but imaginary."*
In this department of treatment, when the patient is not deficient in
credulity, it must be confessed that the audacity of quackery carries it
triumphantly over the conscientious diffidence of regular practice.
Beyond one or two parting words, we will ask no further indulgence.
* Cyclopedia of Piactical Medicine ; under JSIpilppsy.
QUACKEAY IN DISEASES. 397
Is there any single human heing who can . safely boast of having in him
none of the elements of the dupe ! Who is there that has not his weak
side ! Is there any one who is safe from frequent imposition without an
nnrelaxing vigilance ! What a picture does the past history of the world
offer of the craft of knavery and the simplicity of its victims ! Look at the
quick succession in which new Juggernauts have arisen, as the hollowness of
each preceding idol has been exposed. Our age cannot flatter itself that
its intrenchments against the assaults of this kind of imposition are im-
pregnable. Stronger without doubt they are tlian those our predecessors
stood behind. But as the age becomes more wary, the tempter becomes
more wily. Compare astrology with the clumsy inventions which preceded
it. How much more refined and plaunble is the mystery of the horoscope
than the barbarous inspection of the smoking entrails of a ram or heifer !
In the days of Edward the Confessor, or of St Louis, the royal touch for
the cure of king's evil shocked nobodyr-^yet we suspect the practice long
outlasted the faith at least of the court, both in France and England. Dr
Gregory nsed to relate in his lectures that he had seen Louis the Sixteenth
publicly touch for scrofula, and our readers will remember that Samuel
Johnson, when a boy, was brought from Leicester to London to be touched
by Queen Anne. The royal quacks exhibited as much penetration in the
choice of their disease as those that spring up among the cunning vulgar.
The spontaneous healing up of simple scrofula gives origin to the reputa-
tion d multitudes of inert drugs accounted remedies in that disease. And
to pass by the practice of professed quacks, we often meet with old women
of both sexes standing aghast at their own success, if they chance to have
used their nostrum when the ulcers were on the point of closing of their
own accord.
But Hahnemannism is a new era in the history of quackery, at least in
this country. Our age has at last reached, or is approaching, that pitch of
resistance to gross delusion that nothing short of the ti'tmscendental can
make a profitable impression. In certain spots of Germany is the soil in
which transcendentalism, like the ICosicrucian illumination of old, delights
to blossom and bear fruit.
Let the world continue to shut the eyes to the real nature of diseases and
remedies, and to the proper office of medical practitioners, and this fertile
soil will not fail to gratify their longings for novelties with fresh forms of
delusion, transcendental in every feature, long after Hahnemannism has
ceased to stink in the nostrils. It is Goldfuss or Goldbeck (both are equally
transcendental), who wrote a book, ^' On the meaning of 0, or the firet
dawn of light in the horison of truth." Whatever the book may be, here
is a title out of which a thousand Hahnemannisms might be manufactured*
To such follies common sense is the only antidote. Their complaint
that we will not listen to them is as reasonable as that of the madman,
who some years back tried to demonstrate that men live within this planet,
and not on its outer surface. To reason against them is labour lost. To
call in question their facts is to waste words on ur. Against their favourite
proof, vehement assertion, the voice of Stentor himself would make no
head. For if put down in matter of fact, they will not scruple to deny the
value of facts in evidence, and claim the privilege of transcendental minds
to believe through what they call pure conception. This is undeniably the
school of philosophy to which Hahnemann belongs.
If e£Bsct9 so astonishing have flowed ii'om the homoeopathic infinitesimals
which only approach to nothing, what may not be anticipated from the mys-
tical contemplation of itself under the presiding genius of Dr Goldbeck I
398 LAST OF GRUSS POPULAR DELUSIONS.
It is already, in short, almost an assured fact that quackery will hereafter
make its more ambitious assaults on the public credulity in Britain through
the medium of the still unfamiliar language of German mysticism. Homoe-
opathy is but the van of the assailants. It has tasted of the &t of the land.
What though another lustrum or two, its charm of novelty lost, will see it
swept with ignominy from our shores. Its success, though transient, will
tempt new assailants, as the spoils of the empire did the Goths and Vandals
of old, in spite of the unceasing destruction of the first invading hordes.
As the north was then the ** ofiicina virorum," so Germany is now the true
** circumforaneorum ofiicina."
Far be it from us to make a general charge against the science of
(jermany. We acknowledge its claims to the highest rank among the
nations that cultivate medicine on a right basis. The school from which
Hahnemannism sprung, and from which we sorely anticipate many adven-
turers like Hahnemann, unless the public of this and other European
countries be true to themselves, is composed of a comparatively limited
number, and is confined chiefly to the minor universities. There are
amongst them, however, many men of high learning, and of just preten-
sions to reputation, at least in the descriptive sciences. But who does not
know that such qualities are perfectly compatible, not only with the
want of wisdom, but of plain sense, and even with but a small share of
honesty! These men confound themselves with metaphysics, w^hichare
foreign to their proper pursuits. They misunderstand their countryman
Kant, and wrest his doctrines to their own confusion. From him unques-
tionably they borrow the idea of conviction by an inward conception with-
out the evidence of facts. But as far as we are acquainted with his worka^
which is but scantily, he nowhere lays this down of cases to which feusts
observed by sense are applicable. It is of the operations of mind^ of the
conscious self, that he speaks.
However this may be, the mysticism of Kant's language, and still more
the extravagant phraseology of his self-called followers, are very subversive
of common sense in weak minds, and prepare them for the reception of any
absurdity which is couched in the gibberish of a sect. This explains
why men can gravely read and tolerate downright nonsense, such as what
we quoted from Dr Wood's reply a few pages back regarding the proper-
ties of drugs, instead of casting off the yoke at once, and crying oat with
the rest of the world, '< admissi teneatis risum amici."
Here we have not merely the loud assertion as of old in favour of the
quackery that seeks for favour, but assertion couched in language that
cannot be understood. And there is of coui'se an attendant threat, actual
or implied, of denouncement of Dummheit (stupidity) against all who are
bold enough to confess their slowness to understand. And how many are
there in every community who are not gifted with this boldness ! Ajid is
it not at once apparent, that those who are least capable of pronouncing
whether the point affirmed be or be not at all intelligible, will most readily
receive the affirmation unquestioned, because they stand most in dread of
the accusation of slowness !
Such then is the insidious nature of the influences on which those quack-
cries will rest of which, as we firmly believe, homceopathy is the foremnner.
Against the farther introduction of this poison into the land we would
raise our voice, and call on our fellow-citizens to arouse from their slumber,
and save their own mmds, the minds of their mves, and of their children,
from the mischievous effects of such modes of thinking, and from the un-
hinging power of such delusion's.
FACTS BEARING ON VITALISM, 399
Part III— PERISCOPE.
ANATOMY AND PHYSIOLOGY.
Critic€U Ewamin€ttion of the Facts bearing on VitetlUm.
At the Royal Academy of Medicine of Paris, on the 13th of August, M.
Virey read a short memoir, of which we oflFer the following translation : —
It has heen said there is a unity in nature. And in truth there are
some minds which so confound the principles of the physico-chemical
sciences with those of the physiological sciences as to hecome persuaded that
the former are all-sufficient to originate the phenomena of life and oigani-
nation. The attractions more or less complex hetween the chemical ele-
ments of our earth appear to some spirits of modem times to have caused
the spontaneous production of living heings during the long night of ages.
Hence has arisen the idea, particularly prevalent in Germany, that matter
alone reignSy or that the several elements of our glohe possess amongst them
the dispersed forces of vitality in a cryptobio state (state of latent life), yet
capable, under favourable circumstances, of combining their properties for
the production of balanced systems or organic forms. Here then the theory
of spontaneous generation still maintains its ground.
The same principles result from the system termed the system of the
philosophy of nature, or of autocratic pantheism. This system recognises
■in the universe but one substance which has a double aspect, and possesses
extension in its capacity of matter, and intelligence in its capacity of
thought. But thought cannot be manifested, according to the abettors of
this hypothesis^ except in connexion with the organism developed in ani-
mals.
But we have no disposition to believe that the bronze or marble of a
statue has essentially in itself, or virtually contains, the elements of the
sensibility and animating thought which Pigmalion sought in his Galatea,
or that the radical atoms of carbon, azote, hydrogen, oxygen, &c., dissoci.
ated and dispersed by the death and putrefaction of a human brain, take up
fragments of the ideas or of the perceptions which, during life, had the
power of influencing them. The same fault is chargeable against Leibnitz's
brilliant system of monads, which he represents as each containing an
epitome of the properties of the universe.
Whatever may have been the first dark origin of things, we see at once
and clearly conceive an original inert matter, fixed or in motion, of its pro-
per nature independent of every living thing and of prior existence in our
planet. It is only in the language of poetry that our globe is said to live,
that'lhe rocks of the earth can be spoken of as feeling or breathing.
No Spinos% or Schelling, or Oken, or Carus, or Cabanis, or Lamarck,
has been found to impute intelligence, or affections, or passions to the
primitive inorganic mass of the globe^ for example to its granite ; and this
we proceed to show.
Thus every kind of matter is not capable of taking on life. Arsenic,
mercury, copper, lead, baryta, &c., resist organization, or destroy it. Other
mineral elements, silica, lime, &c., may enter freely into combination with
animal tissues without themselves becoming endowed with life^ as in the
400 FACTS BEARING ON VITALISM.
calcareous phosphate of the bones, salts, and shells. There are then sub<
stances unsusceptible of life, and others capable of destroying what is IWing.
Of this kind are the purely chemical unoTgaliizable poisons. The combina-
tions of these being inimical to all vitality, are resisted and thrown off.
We must therefore acknowledge two kingdoms quite distinct and sepa-
rable from each other, since the inert, the primitive mineral kingdom
(indigesta moles), can of itself exist, representing our planet anteriorly to all
organization, and to all life such as we are acquainted with.
The mineral atom or molecule, says Kant, has in itself the motive of
its existence ; and this is why it remains for ever indifiBerent to motion as
to repose. It is therefore concentrated on itself by a physico-chemical
force, which is crystallization. In truth, granite, the primitive matter, as
far as we know, of the globe, is made up of primat^' radicals which have
undergone combustion, the oxides of terrigenous metals, silicium, alumi'^
nium, &c., fused and crystallized. Every substance liquefied by heat or dis-
solved in water is more or less susceptible of erystallizationi Crystalliza*'
tion thus offers the primordial form of every inorganic substance ; for even
in organized bodies whatever remains in the crystalline and concrete state
does not participate in actual life, as salts, acids, stearine, urea, &c.
And from the established fact that a mineral is made up, even in its ulti^
mate particles, of crystals, the juxtaposition of its particles can only give
rise to geometrical angular solids, as Hauy, Mitcherlidh, and other minera-
logists have proved. It is therefore incapable of growth by intussusception
like the solids of a living body, of nutrition, of reproduction, and of death.
Thus it is permanent. Each particle being independent of the rest of the
mass, may be separated from it, but there is no putrefaction. Moreover, the
minerals composed of elements which have undergone combustion, or to
the most part of oxides of terrigenous metals, combine after the binary law,
OS Berzelius speaks, of inorganic salts. The versatility of life is unsuitable
to the inconvertible nature of these radicles, since iron, lime, silica, and
other purely mineral substances, sulphates, hydrochlorates, phosphates, &c.,
which penetrate into living bodies, never by themselves t^ke on the vital
movement, though by communication they are influeneed through it.
The only materials susceptible of vitality and of assimilation by nutritioii
are combustible substances, carbon, azote, hydrogen (even when combined
in the form of water with oxygen), and also without doubt sulphur and
phosphorus^ and perhaps some of their combinations more or less permanent.
It will be seen, then, that from dead, crystalline, inactive, <^ themselves
motionless, divisible minerals, the organic tissue differs essentially, or rather
that it has no connexion with them.
On the contrary, the word organization expresses not only a harmonious
union of combustible elements in a state of equilibrium, or attachmg them-
selves by a special force to a common centre of unity, to constitute the tiuff-
tiduai or self, and to become capable of absorbing and assimilating what
accords with its own nature ; but, besides, the manifestation of a preconcerted
purpose of preservation by means of appropriate organs (members and
senses) ; and i^in resistance to destroying forces, and an effort to repro-
duce or multiply itself.
Neither should we with some physiologists of our times confound together
life and organization, which though coSval are not identical — ^for the one is
the instrument, the other is the office or mode of action ; and this lost may
be suspended as in the case of a seed or an egg by cold, drying, and the like.
The material elements then of organic ports do not maidfest life of Uieni-
FACTS BEARING ON VITALISM. 401
selves, but only through the centralizing source of their temporary associa-
tion. In like manner, varions abnormal productions of both organized
kingdoms, parasitic growths and entozoa, become developed and subsist
by the mere communication of vital movement and nutrition, like the satel-
lites carried along by a planet. Of this nature are acephalocysts, fibrous
bodies, &c.
To make it appear how vainly the physico-chemical sciences have been
appealed to for an explanation of life, a short recapitulation of the chief
theories will suffice. The statico-hydraulic mechanics of Boerhaave do not
embrace in their generalization the reparative and conservative manifesta-
tions of the animal and vegetable body ; no more can the Hallerian irrita-
bility of moving fibre explain the development of the embryo chick in the
egg ; the excitability of Brown fails to afford any satisfactory light on the
transmutation of alimentary substances into our tissues and humours ; the
vital chemistry of the modems, no more'tlian the amiient theory of ferments,
embraces in its laws the production of the susceptibilities of sense and motion
in animals; the properties termed vital byBichat and other physiologists
are incapable of themselves of directing the organization of the smallest of
the viscera or of giving imity of action to the members. Again, chemistry
breaks down, disarranges, or destroys the intimate organism of the blood,
the milk, and the spermatic fluid, in analyzing them, and has not the power
to reconstruct them, while life associates and links together their elements
to defend them against all ;putrefaction, or to make them subservient to
assimilation.
But it is in fact the co-operative energy of an assemblage of parts
sympathising for their common defence (though less powerfully in the
vegetable kingdom) which establishes viviiieation in the individual.
Idfe cannot arise ececept from life by the strict -process of generation.
In truth, ever since the microscope was discovered, equivocal generation
has lost its sway. The reproductive germs of the smallest and most
obscure oi^ganic bodies, down to mosses and infusory animalcules, have
been brought to light in our time. A moment's reflection shows that
the atoms disjoined at random in any kind of rottenness cannot have the
skill and foresight to construct the inward vitals or the .ey^s of the most
inperceptible mite any more than those of an elephant, ^e must leave
to the ancients the idea^f monsters arising out of the mud of a deluge.
When we see the most transcendent contrivances stored up in the
nervous system of an ant — ^when we behold unassisted nature laying under
contribution the most mystmous laws of optics and acoustics in the organs
of sense, and the most intricate combinations of chemistry operating in
the secretions — ^vegetation spontaneously showing movements of the com-
pletest concert in the 'blossom, 'and almost the passion of love in fecunda-
tion ; and again, as we admire the astonishing provisions of structure in
the organs of sex to secure the reception of the proper kind of pollen or
spermatic secretion, to the exclusion of others, for the purpose of prevent-
ing allied species from being confounded together,— it is found to be impos-
sible to admit that inert inorganic matter should rise of itself to the
exercise of what must be calleAd wisdom.
Do we not see the display of marvellous and incomprehensible instincts
of preservation in the ovum of an insect abandoned to the relentless in-
clemencies of nature ! The orphaned organism struggles single handed in
conflict with a world without. The most insignificant gnat has an implanted
power of resistance nicely adjusted to sustain the warfare of the elements ;
402 FACTS BEARING ON VITALISM.
but in the bird and the creeping reptile the protective provisions have been
60 wisely adjusted to their respective positions^ that without any percep-
tion of the purposed end, each directs its acts for its complete attainment.
Who does not see ^ere a breath of « wisdom, moving th§ living being
independently of its will, or even in opposition to its will, but for a useful
object, as in love or anger ! This wisdom is neither in the tree nor in the
animal, but already exists fore-traced in the germ (be it ovum or seed),
and shown forth in that natural disposition which develops the sting of
the bee, or the parts of a flower, making them expand in preparation for
a tAak which awaits them in future.
Hence life is this active agent, essentially intelligent, yet devoid of
any external manifestation of intellect. The most profound observers
among the philosophers of antiquity considered it as a '^vx,n (anima),
delegated to each q[>ccific form, comnussioned to readjust the balance
deranged by diseases, to restore or repair the living fiibric after amputar-
tions and loss of substance, to resist, within certain limits, destructive
agencies^ effecting nutrition where it is required, and in extremity sacri-
ficing a mother to her ofispring. Do such &ct6 as those here pointed to fall
within the range of any Epicurean theory of atoms !
Undoubtedly if there be in us a principle distinct from the matter of
our bodies, which at times resists or modifies its tendencies, this internal
autocrateia directing the economy of all organic beings presides over their
reproduction ; it restores to the fcetal offspring of deformed, dwarfish,
maimed, lame, or otherwise defective persons, their pure primordial and
entire forms, e^ter the exact primitive plan ordained for the species. There
is therefore a wise and provident nature, assigning fixed organs so adjusted
to each other as to suit the mode of life in the outward world, instructing
without manifestations of being instructed (««'«% urji) down to insect
forms, or guiding the individual in the circle of its exisjLenc« to the accom-
plishment of the ends of its being.
There are then conclusions in opposition to certain false opinions pre-
vailing and taught in several medical schools of France and Gennaoy, —
which opinions have a pernicious effect on the practice of our art.
1. There are substances essentially inert, which have undergone com-
bustion, inorganic, constituting the mineral mass of our globe, unsnsoep-
tible of life or even hostile to all vitality. The particles of these^ by
juxtaposition, crystallize ; thus, in opposition to the Pantheists, life does not
spring from these.
2. True life exists only in organized bodies developed by generation
from a spherical original (ovule or cell) — a harmoniouB assemblage of particles
acting in one circle of unity, and up to a certain point and during a
definite period of duration resisting the ordinary laws of the physical
world.
d. The substances capable of anatomical combination and of development
from a centre to a circumference are essentially of a combustible nature
(carbon, azote, hydrogen, &c.). In this they differ from minerals, that
they cannot be produced except at the surface of the earth or in the
water, nor without the concurrence of the atmosphere or of oxygen, apd of
a mild heat and even of light.
4. Chemistry proves that carbon predominates in the vegetable tex-
tures, and on the contrary azote or ammonium in the animal. The
latter require the respiration of oxygen to maintain temperature and vital
excitability, while the plant absorb^ carbonaceous aliments.
FACTS BEARING ON VITALISM. 403
5. The specific forms (animal and vegetable) necessarily correspond to
the proportion of organizahle elements and to the presence of the condi-
tions of warmth, light, humidity, and the annual and diurnal movements
of our planet. They are moreover expressive of completeness, health,
beauty. Their structures conform to the habits necessary for a life of
health, or their organization varies with the climate and the situations in
which they are destined to live. It is absurd to suppose that the same
localities and the same circumstances should have originated beings so
<tiffe]%nt from each other as those we see indigenous together.
6. Crystallization develops the forms of the mineral kingdom desti-
tute of life, destitute of the power of reproduction. On the 4!ontrary, all
that lives emanates from a germ (ovum, seed, spore, or gemmule), down to
the microscopic infusoria (as Ehrenberg and other modem observers have
shown) ; for there is a harmonious concurrence of parts relatively to func-
tional purposes even in agamic animals and cryptogamic plants, and a vital
power of resbtance even in the entozoa of regular forms that inhabit our
digestive oigans, since they resist being digested.
7. This harmonious co-operation displays itself in series and groups of
genera and ^ecies of animals, which, like plants, have their alliances, con-
stituting a chain or branchings of a chain of beings cast in analogous
moulds or having like structures. These families, created on a correspon-
ding type and part of a general plan, give conclusive evidence against all
eUeged spontaneous or fortuitous productions. It is then impossible not to
recognise here the results of an order and intelligence incompatible with
inert matter. As it appears to us, a vital principle must necessarily preside
over organized bodies, unceasingly flowing into them or circulating in
them through an uninterrupted succession of generations. And this truth
is demonstrable by fects. — From Ihe Gazette M^icale de PatiSy No. 33^
17 Aout 1844.
SURGERY.
On Vawular Tumour of the Female Urethra. By Sir B. C. Brodie.
There is a disease to which the female urethra is liable, which never occurs
in the male. The patient complains of a great deal of pain on making
water, which is sometimes effected not without difficulty. If you examine
the urethra, you will find a little red vascular tumour, as red as a cock's
comb^ and looking very much like it ; or there may be specks of increased
vascularity near the orifice, not projecting at all, whilst the former vary in
size &om a split pea to a horse bean, and if you touch them they bleed*
When they protrude externally, they are easily cured : snip the tumour off
at its base with curved scissors, and when the bleeding has stopped, touch
the part with nitric acid, or caustic potass ; but you must be pr^ared with
an antidote, to prevent its burning contiguous parts. If .^o« employ the
nitric acid, it should be a solution of bicarbonate of potass yif caustic potass^
then use vinegar. . When it occurs within the urethra, it is more difficult to
manage, for you cannot get at^ it with scissors. You must then gently
dilate the urethra, and by careful examination make out to which surface
it is attached. Suppose (as is most usual) it be the lower surface, you
must be provided with, a smaU canula, stopped up and rounded at one end»
open at the other, hiEkving a handle fixed at a right angle to the open end.
Having intooduced this into the urethra, slide in a stick of caustic, and the
tube will protec*t the remaining port of the urethra ; but its lower sui&ce
404 TWO CASES OF IMPERFOilATB ANUS.
being deficient, allows the caustic to be applied to the part affected ; if you
employ caustic potass, or nitric acid, you must take the same precaution as
I mentioned before. The application generally requires to be repeated
several times. Although this will effectually cure the disease, still it is
sometimes very troublesome, as great care is required not to bum more than
is necessary ; at the same time taking care entirely to remove the disease.
The canula should be allowed to remain in a short time after the caustic
has been removed, and the patient should not make water ; but occasionally,
in spite of all your care, the disease will, after a time, be regenerated ; and
I am disposed to think it is produced by disease in the kidneys. — CHnkal
Lectures by Sir B. C. Brodie, Medical Times, 7th September 184i.
Two Cases qf Imper/orate Anus. By L. Baudelocque, D.M.
Case I. A child, two days old, had not yet evacuated any meconium ; several
enemata being administered,, were returned as given ; there was agitation,
incessant cries, abdomen tense, symptoms of cerebral congestion. The fin-
ger introduced into the rectum indicated the pre^en^e of a membrane,
situated at about an inch from the anus, which, when pierced, allowed the
meconium and a great quantity of gases to escape. The child soon got
well, the opening having been prevented from closing by the introduction
of the little finger from time to time. — Case II. A child, three days'old,
presented the symptoms just enumerated, — rectum ending in a cul-de-sac one
inch from the anus. An opening being made, allowed nothing to escape,
nor could the finger, when introduced into it, discover the colon descendens ;
and, as the child began to vomit meconium, enterotomia was performed in
the manner recommended by Callisen, as follows : — ^The child being placed
on the right side, a longitudinal fold of the skin was raised on the left, and
a transversal incision, one inch in length, was made midway between the
false ribs and the os ilium ; the aponeurosis of the obliquus extemus, and
some of the fibres of the quadratus lumborum muscles were next divided,
and then the colon, distended with, meconium, and of a greenish hue,
became visible ; the intestine was now seized and opened, allowing a great
quantity of meconium and gas to escape ; it was then fixed by several
sutures to the skin. The consecutive accidents were erysipelas, stopped by
a blister, and enteritis, and peritonitis^ which yielded to an application of
six leeches, so that the child is now (eighth day) as well as can be expected ;
it has gained flesh, the stools are normal and regular, but the mucous mem-
brane protrudes as in all oases of artificial anus. The author concludes
with the following remarks: — 1**, Sabatier, Boyer, and subsequent
authors, founding their opinion on the supposed mobility of the descending
colon, said, that the intestine ought to- be fixed to the skin by sutures. This
opinion is erroneous ; the colon is motionless, being firmly fixed, anteriorly
by the peritoneum, posteriorly by an abundant cellular tissue. Had the
suture not been employed in the second case, neither enteritis nor peritonitis
would have taken place. 2dy The incision of the'colon had better be made
transversely than longitudinally, because the lips of the wound will not
retract so much after the operation. Qd, The inferior portion of the colon
ought to be examined, so as to ascertain if a communication cannot be
established between that intestine and the rectum. Finally, says Dr B.,
in terminating, I purpose, in six months- or a year, endeavouring to form
every anus in its normal- position ; and would recommend all accoucheurs
to introduce the end of a finger into the rectum at the birth of the child,
PASSAGE OF MEDICINES INTO THE ANIMAL ECONOMY. 405
for the irritation thus caused is sufficient to produce an evacuation if no
obstacle exists. — Medical Timely from the Proctidings qfthe Acadimie Royale
dee Sciences, sitting 26th August,
MATERIA MEDICA AND DIETETICS.
On the Passage of certain Medicines into the Animal Economy, and on the
Modifications which they undergo. — Tartrate of Potass and Soda, 4*c.
At the meeting of the Royal Academy of Sciences of Paris, on the 12th of
August, M. Millon, in his own name and that of M. Laveran, read a me-
moir on the passage of certain medicines into the animal economy, and on
the modifications which they there undergo.
The authors have made it their object in this memoir to observe the
medicine after it had passed under the influence of the organs, to take note
of the transformations at its exit from the body, as well as of its physio-
logical effects, and to record whatever useful result might be produced.
Their most numerous observations turn on the administration of the tar-
trate of soda and potass. Of this salt they have taken note of 268 exhibi-
tions ; the sulphate of soda was administered 15 times, sulphur 4 times,
and salicine to 10 different patients. In all these observations the medicines
were prepared by themselves ; their dose and the exhibition of them were
carefully watched over. The changes produced on the substances admin-
istered were determined exclusively by the examination of the producl^ of
the urinary secretion.
The double tartrate of soda and potass (Rochelle salt) was made the
subject of experiment first to test the views of authors on a point which
has deservedly attracted attention for some years — the conversion of the
oi^ganic salts of potass and of soda into, the carbonates of the same bases.
It is well known to have been inferred from observations made on animals,
that the transformation of the alkaline tartrates, citrates, and acetates, into
carbonates, is a constant phenomenon. This conversion, according to our
authors, is, on the contrary, far from invariable. Of the variability of this
effect a general notion is afforded by the following statement : Out of 268
exhibitions of the Rochelle salt, 175 were followed by an alkaline state of
the urine in different degrees, 87 by an acid state of it, and in 6 the urine
was plainly neutral. By a certain management, the total expulsion of the
Rochelle Kilt by the alimentary canal may Be effected. Under this man-
agement the passage of the salt by the urme is uncommonly rare. On the
contrary, it is in our power to make this salt penetrate by the channels of
absorption so as to saturate the urine with an enormous dose of alkaline
carbonate. In this case the evacuation of the double tartrate by stool
becomes the exception, and ita evacuation by. this channel is indeed always
incomplete.
It was necessary to ascertain in those cases where the urine was acid or
neutral if the potass and soda had not nevertheless escaped by the urinary
passages, in combination with the tartaric acid still undccomposed or with
some other organic acid. It was possible, moreover, that a part only of the
alkalies should exist in the urine in the state of carbonates, and that
another part should be in.combination with some organic acid. The authors
describe the analytical process by which they determined these several dif-
ficulties. * * * From this process they conclude that the Rochelle
salt could not escape by the urinary passages in the state of tartrate, and
406 PASSAGE OF MEDICINES INTO THE ANIMAL ECONOMY.
when it took the urinary chaDnels it was converted entirely into car-
bonate.
When the Rochelle salt is taken within a short time in large doBca^from
10 to 12 drams at once, its efifect is confined chiefly to the intestinal tube.
Vomiting is rare, but there are usually several liquid stools. It is an ex-
ception that there should be no effect on the bowels, and in this case the
urine acquires an alkaline character. On the contrary, prescribed in a
small dose, or rather in the fraction of a dose, so that from eight to ten
drams &re taken in as many hours, this tartrate produces opposite effects.
In ihiB case purging is the exception, the alkalinity of the urine is the
rule. * * *
The increase in the power of oxidation, rendered very sensible by the
presence of urea in excess in cases un&vourable to the absorption of the
Rochelle salt, led the authors to make some new trials of its therapeutic
applioation. * * * Xhe acceleration of the oxidizing forces induced
them to employ the tartrate in those cases in which it is necessary to im-
pl!Ove a languid nutrition. Its efficacy in such eases obtained extensive
confirmation. The authors confine themselves to reporting some cases in
evidence of the nature of its beneficial tendency. In several cases of hypo-
chondriasis attended with great debility, in phthisis and albuminaria, they
have observed a remarkable amelioration under the use of the double tar-
trate by the method of absorption. But it is above all in the case of dis-
eases characterized by an unusual excess in the secretion of uric acid that
the authors advise this mode of cure to be resorted to.
The sulphate of soda was subjected to the same rules as the Rochelle
salt. As to sulphur, it was impossible to discover its presence in the urine
under any combination. — Gazette Medicate de PariSy No. 3d, 17 Aout 1844.
Nem Cement for the Teeth,
A NEW cement is proposed for the teeth by DrOstermaier, which is founded
on the composition of their enamel. This substance, at first soft, hardens
on being introduced into the cavity of a carious tooth, and renders the
tooth as fit for the office of mastication as those which are still sound.
With 12 parts of anhydrous phosphoric acid 13 parts of pure caustic lime
finely pulverized are to be quickly mixed. This mixture becomes soft, so
that it may be introduced with ease into the cavity of the tooth, and its
exposed surface modelled to the proper figure. Before its introduction the
cavity is to be dried with tissue paper. If the mixture be allowed to dry
too much before being introduced it becomes useless. This drying takes
place within one or two minutes. — See Journal de Pharmacie, Aout 1844.
PATHOLOGY AND PRACTICE OF MEfDICINE.
Recent Additions to Pathology,
CyanoeU. — ^Dr Stille has published an able memoir on this subject m the
American Journal of Medical Science for July, from which our limits only
permit us to make a few brief extracts. Dr S. enumemtes sixteen lesions
or alterations of structure which dissection has revealed in tiiose afiected
with cyanosis* He states the two most prevalent theorisB as to the eause
of the disease.
laty Presence of venous blood in the arterial system (Morgligni, Senac,
Corvisart, Caillot, Labat, Bouillaud, Gintrac).
BECENT ADDITIONS TO PATHOLOGY. 407
2d^ Obstruction to the return of venous blood to the lungs (Louis, Berard,
Bertin, Ferrus),
As the first explanation is an exclusive one, Dr S. very properly contends
that it must, if true at all, be true of all cases. Five cases are then quoted
where the disease existed without any communication by which the admix-
ture could be effected. Not satisfied with this, however, our author next
shows, by the citation of four cases, that even where such communications
exist " there is no proportion between cyanosis and the degree in which the
blood is mixed.'' This is followed up by two cases which establish the
converse of the proposition, and go to prove ^ that complete admixture of
the blood may take place without cyanosis."
It is next shown that in the cases where the admixture of venous and
arterial blood can take place, the cause must act uniformly at all periods.
But out of 77 oases in which defects permitting this occurred, in only 29
was the colour constant in shade and extent ; therefore ^ the variation in the
extent, depth, and duration of the discoloration is inexplicable by the doc-
trine of the mixture of the blood."
On these grounds the admixture theory is rejected ; and if the &ct8 on
which they are based be correct, the objections are certainly valid.
With regard to the second theory, it is assumed that, if true, it should
fulfil the three following indications. —
1. Account satisfactorily for the discoloration of the skin and dyspnoea.
2. Be found in every case of cyanosis.
3. Never exist without the occurrence of cyanosis, or if it does, there
must be some satisfactory explanation of this apparent exception.
It is first shown that contraction, obstruction, or obliteration* of the
pulmonary artery accounts satisfactorily for the discoloration of the skin
and dyspnoea.
Zdf That out of the recorded cases, in only 62 was the pulmonary artery
examined, and that in 53 of these it was obstructed, contracted, or imper-
vious. Dr S. then enters on an interesting examination of these nine appa-
rent exceptions, and finds that, in every one of them, there were other
iViatomicsd peculiarities or lesions sufficient to produce an effect similar to
that which would have resulted from changes in the pulmonary artery.
The third requisite condition is then shown to be fulfilled, that these ob-
structions never exist without producing the disease ; therefore, —
l»f. It is present in every case of cyanosis.
2d, It never exists without the concurrence of cyanosis.
3d, It is an adequate explanation of the most important phenomena of the
The very meagre outline which we have given is sufficient to show the
pliilosophical character of tliis paper. As an example of rigid induction ap-
plied to medicine, we consider it of great value.
New Diagnostic Sign of Typhoid Diseases.
M. Rauque considers coating like mother-of-pearl of the gams between
the molar teeth, and, in cases where leeches have been applied, an indigo
colour of the bites, as pathognomic of typhoid fever. — Joum. de Mid. et de
.Chirurg, prat. Jan. 1844.
• " Imperforation " is the word employed by Dr StUl^; we regret he should have
thonght it necessary to use it.
408 MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN.
PRACTICE OF MEDICINE.
Quinine in Ague. — ^Dr Stratton thinks a single large dose in the interval
cures more rapidly than repeated small doses. — Ed. Med. S^ Surg. Joum.
April 1844.
Treatment of Neuralgia, — Dr Jacques of Antwerp recommends inocula-
tion, hy means of a yaccinating lancet, of a solution of sulphate of morphia.
— Bouchardafe Annuaire de Therap. 1844.
M. Lafargue recommends inoculation in the same way with a saturated
solution of yeratria ; and M. Roclaut^ a Dutch physician, gives nux vomica
in doses of from three to ten grains in the twenty-four hours.
Succinate of Ammonia in Delirium Tremens. — M. Scham has seen the
most furious delirium overcome as hy enchantment, and the disease re-
moved in a few hours, hy the use of this remedy alone. — Journal de Phar-
maciCy March 1844.
Arsenic in Peritoneal Dropsy. — Dr Debavay has treated a case success-
fully. One-twentieth of a grain was given twice Srday. The improve-
ment was notable in six weeks, and in six months all symptoms had ceased,
and the catamenia, which had been suppressed, were restored. — Gazette
Medicate.
Mustard in the Convulsions of Children. — Dr Triplu was led to the em-
ployment of this remedy as an emetic, and finding it arrest in a few min-
utes an attack of convulsions that had lasted five hours, he has employed it
in three other cases with complete success. — Forrtfs New York Journal of
Medicine.
Prophylactic Remedy against Ptyalism, — Dr Schoepf recommends the
following tooth-powder during the administration of mercury to prevent
salivation. Dried alum powdered, 3ij* » powder of cinchona, ^. ; to be
used by means of a soft brush morning and evening.
MIDWIFERY AND THE DISEASES OF WOMEN AND CHILDREN.
We copy from a respected contemporary (No. LXXVI. of the Dublin
Journal of Medical Science) extracts on various interesting subjects : —
Hysteric Spasm of the Diaphragm, as it is styled by the author, Dr Ring-
land, is the first to attract our attention. We have perused the cases
attentively which are detailed in illustration of this subject, and we would
advise the writer, before he again ventures to come before the professional
public, to bestow a little more attention on hysteria than he appears to
have hitherto done. Who ever heard of a case of regular hysteria without
the diaphragm being implicated^ or who ever witnessed a case of hysteria
in which the diaphragm alone was afieeted4 Dr H. might as well attempt
to record cases of fever without any acceleration of pulse. The cases em-
bodied in this communication are in fact genuine examples of a r^:u]ar
hysteric paroxysm, produced Yjj the ordinary causes^ such as mental
emotion and uterine derangement, and cured by the ordinary remedies.
We consider Dr R. much indebted to the patience of the membera of the
Obstetric Society, and not less so to the condescension of the editors of the
Dublin Journal of Medical Science.
Removal of the Uterus by Ligature after Protracted Inversion of Me Organ.
— Twelve years previously, during labour, the uterus had been inverted.
The patient had been attended by a midwife. After the accident she sa£Rered
from a variety of uterine complaints, and different opinions had been enter-
CASE OF IMPERFORATB VAGINA. 409
tained of her ailments. Aa in almost all cases of this nature, her disease
was at last considered a polypus of the uterus. Upon this supposition the
tumour was noosed, hut the proceedins^ occasioned so much pain that it
became necessary to remove the ligature. Some time after this attempt,
irhen the patient was in a very critical condition, Dr Esselman was con-
salted, and entertaining the same opinion of the case as the former practi-
tioner, the use of the ligature was again resorted to. We are not informed
by what apparatus it was applied ; but from abundant experience we are
satisfied tluit there is no contrivance equal to that suggested by the late
amiable Dr Gooch. Dr Esselman informs us that he was only two years
in practice when he undertook the management of this case ; and his inju-
dicious proceeding by tightening the ligature daily, instead of every alter-
nate day, is a sufficient proof of his inexperience. We are indeed astonished
the patient was not sacrificed by consequent mflammation. On the 18th
day after the application of the ligature, the uterus itself, and not a polypus,
dropped into the vagina. There were ulcers in the vagina which emitted
an offensive odour ; to these a solution of the nitrate of silver was applied,
and the sexual canal was preserved in a proper condition with the solution
of the chloride of lime. Except aperients and the occasional abstraction
of blood to obviate congestion, no other remedies were required. At the
end of a year, from the time the uterus was removed, the catamenia had
not returned. In the Dublin Hospital Reports, vol. iii., there are two
cases of this nature detailed : the same treatment was pursued ; both the
patients had a complete recovery ; and when the system had regained its
wonted vigour, the menses in both instances reappeared.
Case of Imperforate Vagina^ by J. Square, Esq., Surgeon. — This case is
interesting in as fieur as it is one of those rare instances in wliich the sexual
canal became obstructed at a particular point in consequence of some
injury during parturition. A bougie was repeatedly passed through the
stricture, and menstruation established. After a time, however, this func-
tion ceased, when Mr S., after haviog secured his patient as if he intended
to operate for lithotomy, divided the stricture, which was followed by an
immense gush of dark grumous liquid. The os uteri, terminating in a large
oval sac, was now felt. A cylinder of oiled silk was introduced to prevent
a renewal of the contraction ; and after a time, sexual intercourse, which
had been interrupted, could now be performed without inconvenience.
We certainly cannot approve of the indelicate exhibition which was made
in performing this trifling operation, which might have been fully as well
accomplished without any exposure whatever by means of a probe-pointed
bistoury, in the hands of any person acquainted with the anatomy of
the oigans involved.
On some qf the Dangerous Complieations of Measles^ by C. Lees, M. B»,
&c. &c. — ^This communication, though devoid of novelty, is nevertheless
interesting and creditable io the industry of Dr Lees, who has availed him-
self of what has been done and said by his brethren both at home and
abroad. Measles, under the epidemic form, has recently appeared in
Dublin, and been rather fatal. The first complication noticed is dark colour
of the papul8e~-4iie rubeola nigra of Dr Willan, we presume — arising from
peculiarity of constitution, local circumstances, and the prevailing constitu-
tion of the atmosphere. Dr L. attaches particular importance to the influ-
ence of the condition of the atmosphere, where a number of children are
crowded together in the wards of a public institution, contaminated by the
effluvium incessantly emanating from their clothes being continually
3f
410 NEW METHOD OF OPERATING FOR HARE-LIP.
drenched with urine. We entirely agree with Dr L. as to the baneful
effects of this latter neglect of nurses among infants, both in and out of
hospitals, such as inflammation of the lai^e cavities, but especially in the
former situation, not only in aggravaling, but even causing formidable dis-
eases. A second, and a very formidable complication, is an affection of the
larynx ; pneumonia is a third ; bronchitis, a fourth ; and ulceration of the
pudendum and rectum a fifth, which last was very formidable. Some of
the cases were complicated with peritonitis and enteritis ; and others with
diarrhoea and lymph on the intestines. In a very excellent communication
on measles, published in the same journal in 1842, by Dr James Duncan,
there was an observation, by that intelligent physician, which ought to be
continually held in view in treating acute diseases of children, viz. that
there are several sources from which danger may be apprehended ; — ^the
highly developed state of the brain, and of its vessels ; the activity of the
capillary circulation ; and the naturally contracted state of the larynx in
young subjects. In autopsies of some of the fatal cases, the lungs were
found much congested, the minute bronchial tubes very vascular, the edges
of the anterior and middle lobes of the lungs presented a well-marked
fringe of hepatization, extending about half an inch into the substance of
the lungs, several extravasated patches beneath the pleura resembling large
petechiae, a dusky red vascularity on the back and on the posterior arch
of the tonsils, with a few firmly adherent patches of yellow lymph. The
tonsils were unaffected, the epiglottis thickened, covered with lymph, and
the subjacent mucous membr^e highly vascular. The same morbid ap-
pearances extended along the passage to the lining of the larynx, which
was vascular and smeared with muco-purulent secretion ; the lungs and
bronchial glands studded with tubercles, and the liver enlarged, pale, and
presenting large white patches which extended into its substance. The
epidemic continued during the months of March, April, and early part of
May, and was more fatal to the younger children, — ^those for example be-
low the age of two years, than to those who were »older. For those in
whom the papule were of a dark colour, ammonia was given internally
with advantage ; fermenting poultices, and afterwards €Ui ointment com-
posed of chloride of lime, opium, and lard, were successfirily applied to the
ulcers on the pudendum ; and ^stimuli with generous diet afterwards di-
rected. The acetate of lead was given to allay the. diarrhoea ; but, during
an acute attack, we consider this a questionable practice, although it suc-
ceeded under the vigilant 8upe»intendence of Dr Lees. We regret that our
limits will not permit us to give more of this excellent communication.
A New Method of Operating far Harelip. — M. Malgaigne commences his
incision at the upper part of the lip, carrying it from above downwards by
means of scissors, descending as low as possible on each side without
detaching the separated portions. The margins of the clefi are then re-
united by pins in their whole extent, except towardstheir free border ; the
flaps are brought from above downwards, and approximated face to face.
The operator then judging of the length which it will be proper to leave
them, to prevent the furrow which is afterwards so much to be dreaded at
this point, shortens and finishes ^hem as he thinks fit, preserving a piece
varying in size according to the extent of the-i^ace which he has to fill.
Union is afterwards effected by approximating them with interrupted
sutures. This plan, when care is observed to place these uniting agents
very near the free margin of the lip, is said to prevent the ungraceM
furrow which results from such operations where the defect has not be^
neatly rectified.
DEATH AFTER REPEATED DOSES OF PHOSPHORUS. 411
Remarkable Case of Malformation of the Heart in a Human Fcettis.'^^
There was only one large artery given off from the heart, and from this the
pulmonary artery originated. The thus united aorta and pulmonary artery
was considerably larger than the aorta of so young a child ought to be. It
proceeded from a large ventricle which appeared at first sight to constitute
the whole of the ventricular portion of the heart. The pulmonary artery
was separated from the ventricle by a semilunar valve, and from a very
large auricle by a tricuspid valve. The large auricle communicated by a
small opening with anoUier auricle the size of a small horse-bean, and Uiis
last with a cavity the size of a swan-shot. The right ventricle and auricle
were separated from each other by small cobweb-membranes, representing
the auriculo-ventricular valve. Into the layer of the two small cavities
entered the vente cave, which were very small. Dr Carron, the reporter
of the case, observes, that in this in all other respects well- developed child,
the circulation was reduced to that of a reptile of the lowest order, very
nearly resembling that of a frog. For three days after birth, the child
seemed in perfect health, but it frequently sighed ; its digestion was regu-
larly performed. On the third day it sighed frequently, its respiration
was more hurried than usual, it became soporose, and its colour was of a
dusky hue, which pervaded the whole body ; but there was no obvious
diminution of temperature. It died on the fifth day.
FORENSIC MEDICINE AND MEDICAL POLICE.
Death after Administration of repeated Doses of Phosphorus,
The following case was recently the subject of a coroner's inquest at Sheffield,
and the rarity of poisoning with phosphorus, besides its own intrinsic in-
terest, induces us to give it a place in our pages.
Mr Bowbottom was requested to visit a child, st. ten, suffering from
paralysis of one side. After a week'iJ preliminary treatment, he prescribed
for it a mass containing six grains of phosphorus,, to be divided into twenty
pills, and one taken night and morning for a day or two : and afterwards, i£
certain symptoms did not take place, then one three times a-day ; these were
continued from May 18 to June 5. From that date until June 10 the patient
took ten drops three times a-day of sulphuric ether saturated with phos-
phorus ; he then received a mixture containing half a drachm of phosphorus
in an ounce and a half of olive-oil. Mr R. told him ** that he must take
eighteen drops in milk four times a-day, — that the medicine would get
stronger every day" (from the phosphorus dissolving gradually in the oil,
it being solid when he received it), — " that he was to diminish two drops
every dose, and to keep diminishing until he was seen again." The directions
were carefully repeated ; and the child's father was told in addition, ** as
soon as the boy began to be the least squeamish, to stop the medicine/'
Two or three days after this he appeared to be suffering from the effects of
the phosphorus, when calcined magnesia and olive-oil mixed with syrup
were administered. Up to the evening of the 19th, Mr R. told the fiither
that his child was improving ; but he died on the second night thereafter.
When seen on the evening of the 19th by a surgeon, the child was in a
state of stupor, perfectly insensible, with violent convulsions, quick
breathing, and increased action of the heart, quick palpitation, and the
pulse quick and small, from 140 to 150 per minute. The medical witness^
on evidence derived from post mortem inspection, attributed the child's death
412 DEATH AFTER REPEATED DOSES OF PHOSPHORUS.
te inflammation of the large intestines and of the brain. For our own part»
we are anable to discover in the account of the dissection any traces of in«
flammation of the brain, — ^the large vessels of the organ appear merely to
have been distended with blood ; softening of the fornix and coipora striata
is mentioned, but its nature is not specified. The appearances in the in-
testinal canal, giving evidence of inflammatioo, were,-*^out two-thirds
down the oesophagps a dark streak an inch and a half in length, and at the
lower extremity two or'tiiree patohesof inflammation just at the tennioation
of the stomach ; in the stomach there were two ulcers, with softening of tiie
mucous membrane at the pyloric extreBiity,aBd the oigan contained about
two ounces of a fluid like coffee grounds, and its anterior sur&ce was of a
bright vermilion hue. ^* The duodenum was healthy, and contained a sim-
ilar dark fluid to the stomach ; the small intestines continued healthy to
the coecum ; here, at the commencement of the valve, we found considerable
inflammation extending through the whole portion of the cc4on ; and the
large intestines highly inflamed, with thickening." — Provinciai MetL and
Surg. Joum. No. 17, 1844.
It is remarkable that Mr R., who, although not a qualified practi-
tioner, does not appear ignorant of the dangerous nature of the remedy
he was employing, should have ventured to give it in such enormous
quantity, when less than an eighth part of that taken by this child
has been known to cause death in an adult. Between the 18th of May
and the 5th of June the boy must have taken from 12 to 16 grains of
phosphorus ; and during the eight days subsequent to this, it is impossible
to estimate the quantity exhibited, from the variable streqgth of the solution
in which it was administered. In Worbe's case, one grain and a half proved
&tal in twelve days ; and in M. Julia Fontanelle's case, three grains were
followed by death in seven days. In fact our only surprise is that Mr
Rowbottom's patient remained uninjured so long. One part of the treat-
ment after the symptoms of poisoning had appeared, viz. the exhibition of
olive-oil and syrupy was highly injudicious ; for Orfila has proved by experi-
ment, as we might d priori have expected, that the efiect of the administra-
tion of oil is to increase in a remarkable degree the activity of the poison.
Mr R. stated in evidence that he had '^ given phosphorus in hundreds of
oases with almost miraculous effects." (Was the patients' recovery one of
ihem \) He affirmed also, that the *' -reason phosphorus is not more used is
the difficulty of administering it." We cannot see wherein can lie the diffi-
culty of administering a substance soluble in ether or oil ; and medical men
are well aware that it is the uncertain and at times unexpectedly violent
action of this substance, which has caused it to be expunged from our phar-
m^opoeias, and disused in practice.
On a review of this case, we would have had little hesitation in giving it
as our opinion that the child died from the eflects of phosphorus. It can be
no proof to the contrary that no phosphorus was taken for eight days before
death ; for the child was seized with symptoms of poisoning with this
substance while taking it, its exhibition was stopped,, antidotal treatment
resorted to, but in spite of this the child died. It is true that death might
have been caused by inflammation of the bowels arising from some other
source than the pho^horus ; but it is unnecessary for us to look for any
other cause, when we have one before us sufficiently obvious, and adequate
to account for all the circumstances of the case, which are in accordance
with the known action of the substance. Indeed, from Mr R.'s own state-
ment^ we might almost conclude that the child died frx>m this cause ; for he
FOREIGN BODY IN THE LARYNX. 413
directed tiie antidote to pliosphonis to be administered ; and, he aays, because
his orders respecting its exhibition were not strictly adheiued to, ^^ the previous
symptoms" (us. the symptoms of poisoning with phosphoms) " returned. "
The symptoms are unfortunately rather scantily given ; but the case forms a
valuable addition to our knowledge of the toxicology of phosphorus.
Fareign Body accidentally lodged in the Larynx.
^ A Child, et. six, accidentally swallowed one of the common brass nails
used by upholsterers in covering chairs; the nail did not pass into the
oesc^hagusy but got into the larynx, where it became fixed, and occasioned
suifocation. The child was brought in this state to the dispensary, where
every means were used for its relief, but in vain. It was at this time com-
pletely asphyxiated. The trachea was opened ; a gush of air came from
the lungs through the incision, but no inspiration followed, although infla-
tion <^ the lungs was resorted to. On post mortem inspection the nail was
found lying in the larynx, with its point upward, in the sinus of the ventricle
of the larynx, and its head downward below the glotUs. Mr Smith (by
whom the case is detailed) observed, that we should not be deterred by the
result qS this case from attempting to restore animation in cases of asphyxia
from similar causes. Some cases were recorded, in which, after tracheotomy
or laryngotomy, the lungs had been successfully inflated even when no air
had gushed from the wounds." — Dublin Journal^ No, 76, 1844.
Part IV.— MEDICAL MEMORANDA.
Ilffects of EemccinatUm in the Prussian Army.
We find in some of the foreign journals just received an account of the
results of revaccination in the Prussian army in the year 1841. It will be
interesting, we think, to our readers to compare the result of tliis revaccina-
tion with Uiose which took place some years back, namely, in 1834 and in
1836.
A general revaccination of the Prussian army having been ordered in the
year 1834, the results were published in an official document, addressed by
the head of the military medical department, Von Wiebel, to the medical
officers in the army, and dated Berlin, 23d June 1815.
1. The number of men vaccuiated was • • . . 44,454
2. Of this number, —
Had distinct marks of previous vaccination . . 33,634
Indistinct marks . 7,134
No marks 3,686
3. The present vaccination was, —
Regular in its course in 16,679
Irregular 12,287
Without any result 15,488
4. Of the number in whom the vaccination fidled (15,488), 4,530 were
revaccinated a second time ; and of these, 866 took the disease,
Tvhlle in the remaining 3,664, no effect was produced.*
* Rust's Magazin, Band xiv., Heft. ]., and Brit, and For. Med. Rev., No. iL
414 PRESCRIPTIONS.
In the year 1836, another general reyacdnation of the army took place,
with the following results : —
1. The number of men revaccinated was • . . 42,124
2. Of this number,-—
Had distinct marks of previous vaccination . • 82,635
Indistinct • • . . . • • 6,645
No marks . . . . . . . . 2,844
8. The present vaccination was, —
Regular in its course in 18,186
Irregular in . 9,940
Without any result * 14^048
4. Of the number in whom vaccination &iled (14,048), it proved suc-
cessful, on repetition, in 1,569, remaining abortive in 12,479.*
During the year 1841, 44^491 men were revaccinated in the Prussian
army. Of this number there exhibited distinct marks of previous vaccina-
tion, 86,182 ; doubtful marks, 6192 ; and no marks whatever, 2567. la
28,£KB8, the revaccination offered a regular course ; in 8085, an irregular
course. In 18,528, it had no result whatever. In 2255 of those in whom
the revaccination failed at first, the efiect was successful on a second trial ;
in 9466, the repetition was unsuccessfiil. Among the individuals revac-
cinated in 1841 or before that date, there occurred in one year one case of
varicella, eight of varioloid disease, but no case of true variola.
An Older has been issued to revaccinate in future all recruits as soon as
they enter the service, and to revaccinate a second time in those in whom
the first trial foils of efiect. — Gazette Medicate Beige.
Prescriptions.
Squill obviates some of the ill effects of opium. If an aperient be added
besides, the good effects of opium may often be obtained when it would
otherwise be inadmissible.
Bfc Pulv. opii,
Pulv. Bcillie, ftfl gr. iii.
Aloes,
Conserve rosa;, flfl gr. ix.
Fiat mass, divid. in pill. vi. squales. Sign, Opiate pills, two at bed-time.
We have remarked very beneficial results in cases of chronic ill health
with tendency to dryness of the skin^ from the continued use of such com-
binations as the following. Besides its diaphoretic effect, it should be re-
garded as alterative.
I)l Resine guaiaci.
Extract, gentians, fifi 3i*
Pulv. ipecacuanhe, gr. xv«
Ft. mass, divid. in pill. xxx. aequales. Sign, Tonic alterative pills, two
twice a-day.
Or if an aperient be required, aloes may be substituted for the gentian,
and then the combination will somewhat resemble the pulv. aloes comp. of
the London Pharmacopeia.
A simple and very effectual treatment of the less severe bowel com-
plaints, so apt to prevail at this season, is the following :-—
R Sulph. magnesise, . . « ^ss.
Aqus menths, , , . gvi.
• Medicinische Zeitung, 1837, Nos. 20 and 21.
UNIVERSITY OF EDINBURGH. 415
Solve. Sign, A wine-glassful to be used at intervals of an hour, till the
bowels have been distinctly acted on by the medicine, and then a pill con-
taining one grain of opium is to be taken. Even where the pain is con-
siderable, and the case threatens to be severe, this simple plan often
succeeds.
University of Edinburgh.
On the Ist of August last, the following gentlemen, 66 in number,
received the degree of Doctor in the University : —
* Propter cUsserteUiones commendaii,
* * FrcBmiie dignati.
OF SCOTLAND.
John William J. Anderson, on the Action and Curative Properties of Gal-
lic Acid.
William Cameron, on the Blood and its Morbid Phenomena.
**Alexander Fleming, an Historical and Experimental Inquiry into the
Physiological and Medical Properties of the Aconitum Napellus.
James Henderson, on Intus-susception.
Claud Buchanan Ker, on Muscular Fibre.
Kelbume King, an Historical Account of Stricture of the Urethra, with
some Remarks on Fistula in Perinso.
James Lee, on Tetanus.
*Thomas Masson Lee, Observations on Typhus and the Epidemic Fever
of 1843.
James Leitch, on Pneumonia.
James Gairdner Lyell, de Vomitn et Remediis Vomitoriis.
John Maitland, on Ulcen^^Simple and Specific.
Andrew Scott Myrtle, on Pneumonia, or Inflammation of the Lungs.
Robert Wellbank Macaulay, on the Pathology and Treatment of Dysentery.
Angus M'Leod, on Insanity.
Robert Nicholson, on Pathological Haematology.
John Forbes Ogilvie, on Respiration.
David Scott, on the Poisonous and Medicinal Properties of Lead.
John Shand, concerning the Position the Operation at the Ankle-joint
promises to hold in i-egard to Surgery.
John E. S. Stewart, on Dysentery.
**Michael W. Taylor, on the Pathology of the Urinary Excretion.
Laurence R. Thomson, on the Phenomena and different forms of Mental
Alienation, with a slight Sketch of the Mental Faculties in a State of
Health.
James Vass, on Erysipelas.
James Williamson, on Hydrocephalus Acutus.
Neville Wood, on the Physical and Chemical Constitution of the Blood.
♦Richard White Young, on the Signs of Pregnancy.
FROM ENGLAND.
Charles Augustus Adey, on the Scirrhus of Carcinoma, as it usually falls
under the eye of the Surgeon.
Alexander Russell Aitkinson, on Pneumonia.
John Byron Bramwell, on Pericarditis.
Frederick James Brown, on the Disorders of Dentition.
Alexander Peile Cahill, on the different Views entertained of the Anatomy
of the Urethra.
416 UNIVERSITY OF EDINBURGH.
Edward Charles Chepmelly on Dietetic ObflerYanoe^ with a Tiew to the
Maintenance of Physical and Mental Health.
William Harria Clanie, on Pneumonia.
*William Garej Coles, on Epidemic Feyen, intermediate between the
Intermittent and Continued Type.
Charles Percy Croft, Observations on Cases of Strangulated Hernia.
Frederick Douglas, on Gonorrhcea.
Geoige Grayling, on the Pathological Changes to which the Blood is liable
— ^their Causes and Effects.
William A. Harland, on Spinal Irritation.
Edmund Hutchison, on Tubercular Phthisis.
James James, on Acute Rheumatism.
Frederick D. Jones, on the Pneumonia produced by the Actions of Narcotic
Poisons.
Thomas C. Jones, on Insanity.
Edward John Kennedy, on Inflammation of the Lymphatics.
Charles H. J. B. King, on Pleuritis.
Geoige William Lillies, on Malaria and Miasm.
Charles Palmer, on Strabismus.
•William Peach, on Bronchocele — its History and Treatment.
Joseph Pearson, on Epilepsy.
•Frank Renaud, on the Ovaries — their Anatomy and Physiology, Com-
parative and Human.
Adrian Stokes^ on Delirium Tremens.
•John Richard Wardell, on the Edinburgh Epidemic Fever of 1843.
Thomas Wright, on Ovariotomy.
FROM IRELAND.
Edmund Barry, on Dropsy.
Allan Brown, on Hydrocephalus Acutus.
Patrick Digan, on Pericarditis.
Richard Dyas^ on Acute Hepatitis.
William Henry Kent, on Cerebral Apoplexy.
** William Leeper, on Greneral Pathology of Nutrition.
Robert GiUman Lord, on the General Structure, Functions, and Diseases of
the Vertebral Column.
•Hugh Pelan, on the Structural Anatomy of the Muscular Tissue, and the
Phenomena of Muscular Contraction.
Thomas Swan, on Aneurism.
FROK JAMAICA.
William James T. Bowerbaak, on Intermittent Fever.
FROM MADEIRA.
•Alexander Halley, Observations connected with the Natural History
and Climate of the Island of Madeira.
FROM MALTA.
Joseph A. R. Harvey, on the Treatment of Popliteal Aneurism hy Modi-
fied Compression.
FROM THE BASrr INDIES.
Henry Huggins Jones, on Intermittent Fever.
James Cook Watson, on Infanticide.
FROM THE WEST INDIES.
William Burt Wright, on Hydrops.
Printed bj OUver dt Boyd, Tweeddale Cooit. High Btnet, Btllnbiirgli.
r
INDEX.
A.
Acetic, Lactic, and Carbonic Acids in
Water-brash, on the Occurrence of
Sarcina Ventriculi along with. By
G. Wilson, M.D., page 182.
Aconite, Death by Poisoning by the
Leaves of. By Alexander Ramsay,
Esq. History — symptoms — post-mor-
tern appearances, 120.
Action and Employment of Digitalis, on
the, in certain Diseases of the Heart.
By Professor Henderson, 1.
Acton, W., Esq. Observations on Dr
Campbell's paper on Congenite Syphi-
lis, 115. .
Acute Rheumatism, Treatment of, 74.
Alimentary Substances, Physiological
Researches upon, 335.
Alison, Professor, Observations on the
best Mode of Registering Deaths, 225.
Alkaline Treatment of Tuberculous Con-
sumption, 344.
Amputation, Neuralgia of the Stump
afWr. By Dr J. Duncan, 370.
Amputation of the Ankle-joint, 338.
Analytical Chemistry, Notice of Works
on, 213.
Anatomy and Philosophy of Expression
as connected with the Fine Arts. By
Sir C. Bell, 204.
Andrew Moir, the late Dr, 87.
Aneurism of the External Iliac, Case of
Ligature of the common Iliac Artery.
By R. Hey, Surgeon, 152.
Ankle-joint, on Amputation of the.
Advantages — mode of operating —
precautions — opinion of M. Malgaine,
338.
Antidote to Poisoning with Carbonic
Acid, Inhalation of Oxygen an, 158.
Anus, two Cases of Imperforate. Ap-
pearance — ^treatment, 404.
Aorta, Perforation of. Case of Fatal He-
morrhage from, by False Teeth im-
pacted in the (Esophagus. By James
Duncan, M.D., 15.
B.
BallingalPs, Sir George, Remarks on
Schools of Instruction for Military and
Naval Surgeons, 208.
Bell, Sir Charles, on the Anatomy and
Philosophy of Expression as connected
with the Fine Arts, 204.
Benevolent, National, Institution — Mrs
Cullen Brown, 362.
Bill for the better Regulation of Medical
Practice throughout the United King-
dom, 311.
Bilocular Uterus, Pregnancy with Im-
perforate and, 85.
Blennorrbcea, use of the Tampon for the
cure of Utero- Vaginal, 286.
Bone, Growth of New, on the Internal
Surface of the Cranium in Pregnant
Females, 83.
Bones in Fracture^ on the General Laws
of Displacement of, 149.
Brown, Mrs Cullen — National Benevo-
lent Institution, 352.
Caesarian Section after Death of the
Parent. By Dr W. Campbell. Symp-
toms — ^mode of operating — parallel
cases — conclusions, 361.
Campbell, William, M.D., Illustrations
of Congenite Syphilis, 8.
Campbell, William, M.D., Unusual
Termination of a Case of Congenite
Hydrocephalus, 114.
Campbell, William, M. D., Caesarian
Section after Death of the Parent,
361.
Campbell, Dr A. D., Contributions to
Infantile Pathology, 237-
Canstatt, Dr, on Cancer of the Eyelids,
68.
Carbonic Acid, Inhalation of Oxygen
an Antidote to Poisoning with, 158.
Carbonic, Lactic, and Ajcetic Acids in
Water-Brash, on ,thi^ occurrence of
Sarcina Ventriculi aH^ng with. By
G. Wilson, M.D., 182.
Changes in Rain Water kept in Cisterns
newly constructed with Lime, means
of correcting the, 287*
Chatin, M., Experiments on the Mode
by which Poisons are absorbed, 149.
Chemistry, Notice of Works on, 213.
Children, Diarrhoea in, treated with In-
jections of Nitrate of Silver, 347.
3 Q
418
INDEX.
Children, Kermes Mineral in Pleuro-
pneumonia in, 286.
Children, Tincture of Opium in the
Scrofulous Ophthalmia of, 34?.
Chlorotic Blood and Urine, Composition
of, and Effect of Ferruginous Pre-
parations — analysis, 346.
Chronic Diseases of the Stomach, Practi-
cal Observations on some of the. By
W. Strange, M.D., 166.
Chronic Satyriasis, Valerianate of Zinc
in Neuralgias and, 281.
Coecum, Inflammation of the Cellular
Tissue adjoining the, or Perityphlitis.
By W. SeUcr, M.D., 172.
Coins and the like. Time required for
the Transit of» through the Intestines
when swaUowed accidentally, 288.
Columns Cames, Inflammation of, a
cause of Insufliciency of Valves, 155.
Condyloma, a Primary Form of Vene-
real Disease, identical with Sibbens.
By David Skae, M.D. Causes— opi-
nions respecting origin — symptoms —
different modes of treatment — ^particu-
lar symptoms — general situation-
accompanying symptoms— complica-
tions — duration — treatment — effects
of inoculation — reasons for considering
it identical with Sibbens — conclusions,
89.
Congenital Syphilis, Case of, with Ob-
servations. By Dr W. Strange, 308.
Congenital Ulceration and Gangrene,
Case of. By T. B. W. Potts, M.D.y
23.
Congenital Ulceration of the Right Leg,
Case of Extensive. By T. Boswall
Watson, M.D., 305.
Congenite Hydrocephalus, Unusual Ter-
mination of a Case of. By William
Campbell, M.D., 114.
Consumption, Alkaline Treatment of
Tuberculous, 344.
Contributions to Infantile Pathology.
By Dr A. D. Campbell, 237.
Com, Death from the paring of, 350.
Cranium, Growth of New Bone on the
Internal Surface of the, in Pregnant
Women, 83.
Cryptogami of the Hur constituting
Herpes Tonsurans (Ringworm). Cha-
racters — microscopic characters, 220.
Cryptogamic Vegetations in the Sto-
mach — treatment, 346.
Curajl)ility of the More Acute Form of
Hydrocephalus, in its earliest Stage,
under active Treatment ; with a Case.
By A. Harvey, M.D., 108, 255.
Curling, T. B., a Practical Treatise on
the Diseases of the Testes, Spermatic
Cord, and Scrotum, 136.
Deafness, on, caused by Hemorrhage
into the Cavity of the Tympanum,
successfully treated by Perforation of
the Membrane ; with Statistic Obser-
vations on the Results of this Opera-
tion. By James Mercer, M.D., F.R.
C.S.E. Cases in which recommended
—tabular view of cases in which oper-
ation performed^-case — ^symptoms —
mode of performing operation — after-
treatment — conclusion, 353.
Death, Cesarian Section after. By Dr
W. CampbeU, 361.
Death, Notice of a Case of alleged Lu-
minous Appearance on the Hand and
the other Parts of the Body, before.
By Dr A. Wood, 368.
Death by Rupture of the Lung fiom Ex-
ternal Violence. By W. Tait, M.D.,
104.
Death by Poisoning with the Leaves of
the Aconite. By Alex. Ramsay, Esq.,
120.
Deaths, on the best Mode of Registering.
By Professor Alison. Main objects —
objection to the English plan — ^Mr
Farr*B objections t^ Professor Alison*s
plan, 225.
Death from the prjing of a Corn, 350.
Diabetic Urine, New Method of detect-
ing Sugar in, 345.
Diagnosis and Treatment of Enlarge-
ment of the Hearty on the. By Pro-
fessor Henderson, 233.
Diarrhoea in Children tveated with In-
jections of Nitrate of Silver. Mode
of Exhibition, 347*
Diet, Letter on Vegetable, 345.
Digitalis, on the Employment and
Action of, in certain Diseases of the
Heart. By Professor Henderson. Its
effects. Case I. — disease— ^ymptonas
— result. Case 11. — disease*- ^mp-
toms — treatment — ^result, 1.
Diseases of the Skin, on. By Erasmus
WiUon, 122.
Disease 6f the Testes, Spermatic Cord,
and Scrotum, a Practical Treatise on
the. By T. B. Curling, 136.
Disease of the Ovary, Cases ef rare Ma-
lignant. By Dr J. C. W. Lever, 161.
Diseases of the Stomach, Practical Ob-
servations on some of the Chronic
By W. Strange, M.D., 244.
INDEX.
419
BUeaMS, New Diagnostic Bigti of
Typhoid, 407.
Displacement of Bones in FractuK^
General Laws of, 149.
Dropsical Ovaria, Walne'S Cases of, 320.
Duncan, James, M.D., Case of Fatal
Hemorrhage from PeHbration of the
Aorta by False Teeth impacted in the
<Esophagus (with a plftte), 15.
Dttncan, Dr J., Neutalgia of the Stump
after Amputation, 370.
Bysmenorrhopa and other Uterine Alf^
tions in connexion with Derangement
of the Assimilating Functions. By
Dr. E. Rigby, 274.
E.
Edinlmrgh Maternity Hespita), Account
of — ^list of medical officers, 160^
Edinburgh, University df— List of
gentlemen who received the degree of
Doctor of Medicine on the 1st of
August last, 415.
Elephantiasis In Norway, 219.
Employment and Action of Digitalis
in certain diseases of the Heart. By
I'rofessor Henderson, 1.
Enlargement oi the Heart, Diagnosis and
Treatmentof. By Professor Henderson,
288.
Ergot of Rye, Effect of, in Paky of the
Lower Extremities— ease — treatment
>— result, 154.
Evacuating the Stomach, Modes of, 350.
Excision of the Head of die Femur, 277*
Experiments by M. Chatin on the Mode
by which Poisofis are absorbed, 149.
Expression, Anatomy and Philosophy of.
By Sir C. Bell, as connected with the
FiAie Arts — history, 204.
Eyelids, Cancer of the. By Dr Canstatt
Progress of disease — onginal seat-*
primary affections which give rise to
H-^appearanee — practical conclusions,
68.
Eyelids, Removal of Encysted Tumours
from the — ^treatment — mode of ex-
amining, 336.
Facts bearing on Vitalism, Critical Ex-
amination of, 399.
Fatal Hemorrhage, Case of, from Per-
foration of the Aorta by False Teeth
impacted in the (Esoptiagus. By
James Dcfncan, M.D«, 15.
Femur, on the Excision of the Head of
the — ^history of the cases-— case in
which recommended-^objections, 377*
Ferruginous Preparations, Effect of, and
• Composition of Chlorotic Blood and
Urine, 346.
Fever in Irish Farm-houses, 352.
Fine Arts, Sir C. BelPs Anatomy and
Philosophy of Expression as connected
with the, 204.
Fistula Lachrymalis, Case of Tetanus
following the Mechanical Cure of, 280.
Fcetus, Comparative Weight and Length
of, bom at the full time, 159.
Fracture, General Laws of Displacement
of Bones in. By M. Edouard liacroix,
149.
Functions, Structure and Relations of the
Nervous System, 66, 147, 214.
Functions, Thoughts on the Mental, 262.
G.
Gangrene and Ulceration, Case of Con-
genital. By T. B. W. Potts, M.D., 23.
Glasgow, Perry on the Sanitary State of,
271.
Gout and Rheumatism, Treatment of— •
French plan — English plan, 340.
Grafenberg, a Medical Visit to, in April
and May 1843, for the purpose of in-
vestigating the Merits of tiie Water-
Cure Treatment. By Sir C. Scuda-
more, M.D., F.R.S., 377-
Growth of New Bone on the Internal
Surface of the Cranium in Pregnant
Women^-appearance — ^mode of de-
velopment — appearance of adjoining
structure— comparative frequency-
conclusions — Professor Rokitanski*8
memoirs — causes-— remarkable case,
83.
Guafacand Iodine, Case of Elephantiasis
cured by, 220.
H.
Hahnemann, Defence of, and his Doc-
trines ; including an Exposure of Dr A.
Wood's *' Homceopathy Unmasked,"
377.
Hair, Cryptogam! of the, constituthig
Herpes Tonsurans (Ringworm), 220.
Hand and other Parts o( the Body after
death. Notice of a Case of alleged
Luminous Appearance on the. By
Dr A. Wood, 36a
Harvey, Alexander, M. D., Curability
of the more acute form of Hydro-
cephalus, in its earliest Stage ; with a
case, 108, 255.
Head of Femur, Bxctnon of the, 277-
Heart, Enlargement of the, on the Dia-
gnosis and Treatment of. By Professor
420
INDEX.
Henderson. — Bad effects of deficiency
of the aortic valves, — interval be,
tween the contraction of the ventricles
and the beat of a distant artery, 233.
Heart, Wound of the, apparently cured.
Cause — symptoms — ^treatment — ^result
— autopsy, 280.
Hemorrhage into the Cavity of the Tym-
panum, Deafness caused by. By Dr
J. Mercer, F. R. C. S. E., 253.
Hemorrhage, Fatal, Case of, from Per-
foration of the Aorta by False Teeth
impacted in the (Esophagus. By
James Duncan, M. D. (with a plate).
Symptoms — treatment — autopsy —
size of false teeth — ^parallel casei —
treatment, 15.
Henderson, Professor, on the Employ-
ment and Action of Digitalis in cer-
tain Diseases of the Heart, 1.
Henderson, Professor, on the Diagnosis
and Treatment of Enlargement of the
Heart, 233.
Hey, Richard, Surgeon, Case of Ligature
of the common Iliac Artery for Aneu-
rism of the External Iliac, 152.
Homoeopathy Unmasked, bemg an Ex-
posure of its Principal Absurdities and
Contradictions, with an Estimate of its
recorded Cures. By Dr A. Wood, 377-
Homoeopathy Unmasked, Sequel to; being
a further Exposure of Hahnemann and
his Doctrines, in a reply to recent
Anonymous Pamphleteers, 377*
Hospital, Edinburgh Maternity, 160.
Hydrocephalus, Curability of the more
Acute form of, in its earliest stage,
under Active Treatment ; with a case.
By Alexander Haivey, M. D. Opin-
ions as to ofirability— case— -symp-
toms — treatment — ^resul t— ^conclusions,
108 ; cases where treatment of no
avail — evidence of curability'in its ear-
liest stage. — Dr Maxwell's treatment
—symptoms, 255.
Hydrocephalus, Unusual Termination of
a case of Congenite. By William
Campbell, M. D. History — appear,
ance of cranium — supposed cause,
114.
Hydrocephalus and Disease of Lungs,
Connexion between. By M. Mauthner,
165.
Hygiene, Mental, Sweetser's, 324.
Iliac Artery, Case of Ligature of the
Common, for Aneurism of the External
Iliac. By Richard Hey, Surgeon, 152.
Illustrations of Congenite Syphilis. By
WUliam Campbell, M. D., 8.
Imperforate Hymen, Case of. By A.
Webster, M. D., 21.
Imperforate and Bilocolar Uterus, Preg.
nancy with, 85.
Imperforate Anns, two Cases of, 404.
Incontinence of Urine during Sleep, or
Eneuresis Noctuma, 348.
Infantile Pathology, Contributions to.
By Dr A. D. CampbeU, 237*
Inflammation, Travers' Pathology of,
abuses in treatment of — ^propositions
authenticated in the pathology — gran-
ulation, 51.
Inflammation of Columnas Cames, a
cause of Insufficiency of Valves, 155.
Inflammation, Pelvic, after Parturition^
156.
Inflammation of the Cdlolar Tisine ad-
joining the CflBCum, or Perityphlitis.
By W. Seller, M. D., 172.
InhiJation of Oxygen, an Antidote to
Poisoning with Carbonic Acid, 158.
Injections into the Uterine Cavity, Risks
attending on, 285.
Injections of Nitrate of Silver, DiairhiBa
in Children treated with, 347*
Inoculation with Tartar-Emetic to pro-
duce a counter-irritant Eruption on the
Skin, 154.
Insanity, Statistics of the Transmission
of. Is hereditary insanity more fre-
quently derived ftom the mother than
the father? — is the disease of the
mother communicated to a greater
number of children than is the disease
of the father ? — ^is insanity more com-
monly transmitted to daughters ftom
the mother, and to sons from the father?
348.
Institution, National Benevolent— Mrs
CuUen Brown, 352.
Intellectual and Physical Life, Wright
on, 273.
Iodine and Mercury, on the Treatment
of Syphilis by, 282.
Iodine and Guaiac, Case of Elephantiasis
cured by, 220.
loduret of Potassium in Saturnine Af-
fectbns, 156.
Keratoplastie. Definition'— flrganism of
reunion, 217.
Kermes Mineral in Pleuro- Pneumonia
in Children, 286.
Rieman*s Views of the Structure of the
Liver, Doubts as to, 276-
INDEX.
421
Lactic^ Acetic, and Carbonic Acids in
Water-brash, on the Occurrence of
Sarcina Ventiiculi along with. By
G. WUson, M.D., 182.
Larynx, Foreign Body accidentally lodg-
ed in the, 413.
Laws of Displacement of Bones in Frac-
ture, on the General, 149.
Lee, B., M.D., on the Theory and Prac-
tice of Midwifery, 190.
Leg, Case of Extensive Congenital Ul-
ceration of the Right. By T. Bos-
wall Watson, M.D. Appearance —
result — supposed cause — condusions
—parallel cases^ 305.
Length and comparative Weight of Foe-
tus bom at the full time, 159.
Letter on Vegetable Diet, 343.
Lever, J. C. W., M.D., Cases of rare
Malignant Disease of the Ovary, 161.
Lever on Organic Diseases of the Uterus,
35.
Life, Physical and Intellectual, Wright
on, 273.
Ligature of the Common Iliac Artery for
Aneurism of the External Iliac, Case
of. By Richard Hey, Suigeon. Pa-
rallel cases — ^previous history — symp-
toms — ^mode of operation — result, 152.
Liver, Doubts as to Eliernan^s Views of
the Structure of the, 276.
Luminous Appearance on the Hand and
. other Parts of the Body before Death.
By Dr A. Wood, 368.
Lung, Death by Rupture of the, from
External Violence. By W. Tait,
M.D. Previous history— external ap.
pearances -— sjrmptoms — treatment—
result — autopsy — ^parallel cases, 104.
Lungs, Disease of, Connexion between,
and Hydrocephalus, 155.
M.
Malignant Disease of Ovary, Case of
rare. By J. C W. Lever, M.D., 161.
Manslaughter, Trial of a Surgeon for ;
Case of Rupture of the Vagina, 322.
Maternity Hospital, Edinbui^h, 160.
Means of correcting the Changes which
take place in Rain- Water kept in Cis-
terns newly constructed with Lime,
287.
Medical Practice, a Bill for the better
Regulation of, throughout the United
Kingdom, 311.
Medicine, Practice of. Quinine in Ague
— Treatment of Neuralgia — Succinate
of Ammonia in Delirium Tremens—
Arsenic in Peritoneal Dropsy — Mus-
tard in the Convulsions of Children—
Prophylactic Remedy against Ptyalism,
408.
Medicines, on the Passage of certain,
into the Animal Economy, and on the
Modifications which they undergo.
Tartrate of Potassa and Soda, &c.,
405.
Mental Functions, Thoughts on the.
Contents : On the Analysis of Pheno-
mena-— on Mental Analysis — on As-
sociation and Secretion— -on Sensation
and Volition — on Hearing and the
Voice— on S3rmpathy and Expression
—on the Faculty of Enumeration — on
the Craniology of Dr Gall, 262.
Mental Hygidne, Sweetser^s, 324.
Mercer, Dr James, F.R.C.S.E., on Deaf-
ness caused by Hemorrhage into the
Cavity of the Tympanum, 353.
Mercury and Iodine, on the Treatment
of Syphilis by, 282.
Midwifery, &.c. Removal of the Uterus
by Ligature after protracted Inversion
of the Organ — case of Imperforate Va-
gina—on some of the dangerous com-
plications of Measles — a new method
of operating for Hare-lip — ^remarkable
case of Malformation of the Heart in
a Human Foetus, 408.
Midwifery, Theory and Practice of. By
R. Lee, M.D., 190.
Military and Naval Surgeons, Sir George
Ballingall*s Remarks on Schools of
Instruction for, 208.
Milk, on Testing the Qualities of s
Nurse's, 287.
Moir, the late Dr Andrew, 87.
Murder, how far is a Prisoner accused
of, held guiltless, provided the De-
ceased has had a surgical operation
performed upon him ? 224.
Murder, Trial of Samuel Clark on a
charge of, by stabbing in the Vulva.
By William Tait, M.D. History —
post-mortem appearances — conclu-
sions, 297.
Musk, Trismus Neonatorum treated
with, 286.
N.
National Benevolent Institution — Mrs
CuUen Brown, 352.
Naval and Military Surgeons, Sir G.
Ballingall's Remarks on Schools of
I Instruction for, 208.
422
IXDSX.
Nervous System, on the Stnicture, Re-
lations, and Functions of the. Aggrega-
tion — structure of the cord — aggrega-
tion of fibres-— ganglionic set of fibres,
the fibres of reinforcement of the cord,
66, 147, 214.
Neuralgia of the Stump after Amputa*
tion. By Dr J. Duncan, 370.
Neuralgias and Chronic Sat3rriasis, Vale-
rianate of Zinc in, 281.
Norway, Elephantiasis in, 219.
Nurse's Milk, on Testing the Qualities
of, 287.
Observations on Dr Gampbeirs Paper on
Gongenite Syphilis, in the first number
of this Journal. By W. Actoo, Esq.,
116.
Observations, Practical, on some of the
Chronic Diseases of the Stomach. By
William Strange, M.D., 165.
Observations on the best Mode of Regis-
tering Deaths. By Professor Alison,
226.
Oil of Skate-Liver, 218.
Oldham, Dr, on Polypus Uteri and its
Co-existence with Pregnancy, 221.
Ophthalmia of Children, Tincture of
Opium in the Scrofulous, 347.
Opium, Tincture of, in the Scrofulous
Ophthalmia of Children — ^mode of
treatment, 347.
Organic Diseases of the Uterus, Lever
on the, 36.
Ovaria, Walne^s Cases of Dropsical, re-
moved by the Large Abdominal Sec-
tion. History of operation — after-
treatment, 320.
Ovarian Enlargement, Pregnancy com-
plicated with. By Dr SomerviUe,
307.
Ovary^ Case of Rare Malignant Disease
of the. By J. C. Lever, M.D.
Previous history — symptoms— treat-
ment — ^result— autopsy. Parallel case
. -—symptoms — treatment — result-
autopsy — microscopical examination
of the morbid structure, 165.
Oxygen, Inhalation of, an Antidote to
Poisoning by Carbonic Acid. Case-
symptoms — treatment — result •— an-
alysis of blood, 168.
Palsy of the Lower Extremities, Effect
of Ergot of Rye in, 164.
Pathology, Contributions to Infantfle.
By Dr A. CampbelL Two cases of
Icterus Gravis Infantum from Defi-
ciency of the Hepatic and Cystic
Ducts, and one from firm plugging of
the Common Duct. History — symp-
toms — treatment -^-autopsy— -parallel
cases — conclusion, 237.
Pathology, recent Additions to. Cyano-
sis, 406.
Pelvic Inflammation after Parturition.
Diagnosis — symptoms — treatment,
156.
Penitentiary, Variations in the Weight
of Prisoners subjected to the Regimen
of a, 341.
Perforation of the Aorta, Case of Fatal
Hemorrhage from, by False Teeth
impscted in the (Esophagus. By
James Duncan, M.D., 15.
Perityphlitis, or Inflammation of the
Cellular Tissue adjoining the Coeeum.
By W. Seller, M.D. History— eymp.
toms— cases, 172.
Perry on the Sanitary State of Glasgow,
271.
Philosophy of Expression as connected
with the Fine Arts, 204.
Phosphorus, Death after Administratioii
of repeated Doses of, 411.
Physical and Intellectual I^e, Wright
on, 273.
Physiological Researches upon Alimen-
tary Substances, 335.
Physiology of Inflammation, Travers*,
50.
Play&ir, Lyon, Ph.D., on Sleep, and
some of its concomitant Phenomena,
24.
Pleuro-Pneumonia in Children, Kermes
Mineral in. Mode of treatment, 286.
Poisoning by the Leaves of the Aconite,
Death by. By Alex. Ramsay, Esq.,
120.
Poisoning, Case of Suspected, by an
Over-dose of Tartar Emetic, sent out
by a Non- Professional Dispenser. By
Dr Ebenezer Skae, 289.
Poisoning with Osrbonic Acid, Inhala-
tion of Oxygen an antidote to, 158.
Poisonn, Experiments on the Mode by
which, are absorbed. By M; Qiatin.
Experiments— concluirions, 149.
Potassium, loduret of, in Saturnine Af-
fections. Mode of treatment, 156.
Potto, T. B. W., M.D., Case of Con-
genital Ulceration and Gangrene, 23.
Practice and Theory of Midwifery. By
R. Lee, M.D., 190.
Practice of Medicine, 408.
Pregnancy complicated with Ovarian
INDEX.
423
Enlargement. By Samuel SomerviUe,
M.D. History— parallel case, 307*
Pregnancy, Dr Oldham on Polypus
Uteri and its co.existence with, 221.
Pregnancy, with Imperforate and Bilocu-
lar Uterus. Appearance — symptoms
i-^result — autopsy — conclusions, 85.
Pregnancy, Term of exceeded by four
weeks. Previous history — symptoms
—result — conclusions, 85.
Pregnant Women, Growth of New Bone
on the Internal Surface of Cranium in,
83.
Prismatic Reflection, Warden on the
Application of, to the Investigation of
Diseases situated in the open Cavities
of the Body. Description of instru-
ment — • principle— advantages — con-
clusions, 210.
Prisoners^ Variatious in the Weight of,
subjected to the Regimen of a Peni-
tentiary, 341.
Q.
Qualities of a Nurse^s Milk, on Testing
the, 287.
Quinine, Sulphateof, Toxicological effects
of. By M. Monneret. Symptoms
Tprhen taken internally-*- effect9 on other
functions, 86.
Rain Water kept in Ciatems newly con-
structed with Lime, Means of correct-
ing the Changes which take place in,
287.
Ramsay, Alexander, Esq., Case of Death
by Poisoning wiUi the Leaves of the
Aconite, 120.
Regimen of a Penitentiary, Variations
in the Weight of Prisoners subjected
to the, 341.
Registering Deaths, Observations on the
best mode of. By Professor Alison,
22 d.
Relations, on the Structure, Functions,
and, of the Nervous System, 66, 147,
214.
Removal of iincysted Tumours from
the Eyelids, 336.
Researches^ Physiological, upon Alimen-
tary Substances, 335^
Re vaccination. Effects of, in the Prussian
Army, 413.
Rheumatism and Gout, Treatment of,
340.
Rheumatism, Treatment of Acute. Pure
antiphlogistic treatment — effects-
purgatives— stimulant sudorific treau
nient — ^pure stimulant plan — calomel
and ophim plan^-specific remedies—
colchicum — nitre — ^iodine — ^hydriodate
of potassa — Dr Hope's plan — blue
pill*.— treatment in acute sta^, 74.
Rigby, pr E., on Dysmenorrhea and
other Uterine Affections in connexion
with Derangement of the Assimilating
Functions, 274.
Risk attending on Injections ipto the
Uterine Cavity, 285.
Rupture of the Lung, Death from, by
External Violence, by W. Tait, M.D.,
104.
Rupture of the Vagina, C^e of. Trial
of a Surgeon for Manslaughter, 322.
S,
Sanitary State of Glasgow, Perry on the,
27L
Sarcina Ventriculi, Acetic, Lactic, and
Carbonic Acids in Water-Brash, on
the Occurrence of. By G. Wilson,
M. D. How obtained — charactera—
character of fluid ejected — chemical
characters — supposed cause, 182.
Saturnine Affections, loduret of Potas-
sium in, 156,
Satyriasis, Valerianate of Zinc in Neu-
ralgias and in Chronic, 281.
Schools of Instruction, Sir G. BalUngall's
Remarks on, for Military and Naval
Surgeons, 208.
Scrofulous Diseases, Walnut Leaves in
several varieties of, 340.
Seller, W., M. D., on Perityphilitis, or
Inflammation of the Cellular Tissue
adjoining the CcBCum, 172.
Sewing-Needle, Wound in the Th(»ax
from a Common, 350.
Sibbens, identical with Condyloma, a
primary form of Venereal Disease.
By D. Skae, M. D., 89.
Silver, Nitrate of. Diarrhoea in Children
treated with Injections of, 347*
Skae, Dr Ebenezer, Case of Suspected
Poisoning by an Over-dose of Tartar
Emetic, sent out by a Non- Professional
Dispenser, 289.
Skate-Liver Oil. Advantages over Cod-
liiver Oil — method of obtaining it-
character, 218.
Skin, a Practical and Theoretical Trea-
tise on the Diagnosis, Treatment, and
Pathology of Diseases of the, arranged
according to a Natural System of Clas-
sification, and preceded by an Outline
of the Anatomy and Physiology of the
Skin. By Erasmus Wilson, 122.
424
INDEX.
Skin, Inoculation with Tarttf-Emetic,
to produce a Counter Irritant Eruption
on the Skin, 154.
Sleep, and some of its Concomitant
Phenomena. By Lyon Playfair, Ph.
D. State of body in sleep — what will
cause sleep, 24,
Somerville, Dr Samuel, Pregnancy com-
plicated with Ovarian Enlargement,
307.
Statistics of the Transmission of Insanity,
348.
Stomach, Cryptogamic Vegetations in,
346.
Stomach, Modes of Evacuating the.
Male catheter-^gullet tube, 350.
Stomach, Practical Observations on some
of the Chronic Diseases of the. By
William Strange, M. D. Causes —
proposed mode of classification — atony
of the stomach — symptoms — causes —
treatment— -atonic morbid irritability
-^symptoms — treatment — cautions to
be used in treatment—- causes — acute
morbid irritation — ^symptoms — treat-
ment, 244.
Strange, William, M. D., Practical Ob-
senrations on some of the Chronic Dis-
eases of the Stomach, 244.
Strange, William, M.D., Case of Con-
genital Syphilis, with Observations,
308.
Structure of the Liver, 276.
Stump, Neuralgia of, fffter Amputation.
Return of the Neuralgia. By Dr J.
Duncan. Symptoms — treatment —
result of operation — ^return of neural-
gia — appearance of parts removed —
parallel cases — conclusions, 370.
Sugar in Diabetic Urine, New Method
of detecting, 345.
Sulphate of Quinine, Toxicological
Effects of. By M* Monneret, 86.
Surgeon, Trial of a, for Manslaughter ;
Case of Rupture in the Vagina, 322.
Sweetser*s Mental Hygiene, 324.
Syphilis, Congenite, Illustrations of.
By William Campbell, M.D. Symp.
toms— treatment, 8.
Syphilis, Tartar-Emetic as a remedy
for, 156.
Syphilis, Case of Congenital ; with Ob-
servations. By William Strange,
M. D. Case-— previous history —
treatment — appearance of child — treat-
ment of child — treatment of mother^
308.
Syphilis, on the Treatment of, with
Mercury and Iodine. Is the plan of
treatment by mercury and iodine su-
perior to any other? — comparative
value of mercury and iodine — indu-
rated chancre — ^phagedenic chancre —
warts and fungi — ^bubo — constitution,
al syphilis— skin diseases — fissures—
condylomata — affections of throat,
mouth, and nostrils— tertiary symp.
toms — syphilitic tubercles— calomel
.—bichloride of mercury — ^pill. hydrarg.
— proto-ioduret — iodine, 282.
Tait, William, M.D. Case of Death
by Rupture of the Lung from External
Violence, 104.
Tampon, Use of the, for the Cure of
Utero- Vaginal Blennorrhoea. Mode of
use — result, 286.
Tartar Emetic, Case of Suspected Poi-
soning by an Over-dose of, sent out
by a Non.Professional Dispenser. By
Ebenezer Skae, M.D. Previous his-
tory — symptoms — autopsy — chemical
analysis of fluid found in the stomach,
289.
Tartar Emetic, Inoculation with, to pro-
duce a Counter-irritant Eruption on
the Skin. Mode of inoculating, 154.
Tartar Emetic as a Remedy for Syphilis.
Effects — mode of treatment, 156.
Teeth, New Cement for the. Mode of
preparation, 406.
Terra of Pregnancy exceeded by Four
Weeks, 85.
Testes, a Practical Treatise on the Dis-
eases of the, and of the Spermatic Cord
and Scrotum. By T. B. Curling.
Descent of testes — use of cremaster
muscle — opinions as to the formation
of the cremaster muscle — ^gubemacu-
lum testis — insertions — uses — ^mode
of descent of the testicle into the
scrotum, 136.
Testing the Qualities of a Nurse^s Milk,
287.
Tetanus, Case of, following the Mechani-
cal Cure of Fistula Lachrymalis.
Cause— symptoms — treatment — re-
sult — autopsy — ^parallel cases, 280.
Theory and Practice of Midwifery, By
Robert Lee, M.D., 190.
Thorax, Wound in Uie, from a common
Sewing Needle, 350.
Thougiits on the Mental Functions, 262.
Tincture of Opium in Scrofulous Oph-
thalmia of Children, 347*
Toxicological Effects of Sulphate of Quin-
ine. By M. Monneret, 86,
INDEX.
425
Transit of Coins and the like through
the Intestines when swallowed acci-
dentally, time required for the, 288.
Transmission of Insanity, Statistics of,
348.
Treatment of Acute Rheumatism, 74.
Treatment of Enlargement of the Heart,
on the Diagnosis and. By Professor
Henderson, 233.
Treatment of Gout and Rheumatism, 340.
Treatment of Syphilis hy Mercury and
Iodine, on the, 282.
Trial of Samuel Clark on a Charge of
Murder, hy Stabbing in the Vulva ;
with Remarks. By Dr W. Tait, 297.
Trial of a Surgeon for Manslaughter.
Case of Rupture of Vagina, 322.
Trismus Neonatorum treated with Musk.
Post-mortem appearances — treatment,
286.
Tuberculous Consumption, Alkaline
Treatment of, 344.
Tumour, Vascular, of the Female
Urethra, 403.
Tumours from the Eyelids, Removal of
Encysted, 336.
Tympanum, on Deafness caused by
Hemorrhage into the Cavity of the.
By Dr J. Mercer, F.R.C.S.E., 353.
Typhoid Diseases, New Diagnostic Sign
of, 407.
U.
Ulceration and Gangrene, Case of Con-
genital. By T. B. W. Potts, M.D.
Appearance — ^result, 23.
Ulceration of the Right Leg, Case of ex-
tensive Congenital. By T. Bos wall
Watson, M.D., 305.
University of Edinburgh, 415.
Urethra, on Vascular Tumour of the Fe-
male. Appearance — treatment, 403.
Urine, New Method of detecting Sugar
* in Diabetic, 345.
Urine and Chlorodc Blood, Compontion
of, and Effect of Ferruginous Prepa-
rations, 346.
Urine, Incontinence of, during Sleep, or
Eneuresis Noctuma, 348.
Utero- Vaginal Blennorrhoea, Use of the
Tampon for the Cure of, 286.
Uterus, Lever on Organic Diseases of
the. Contente : Comparative fre-
quency of functional and organic Dis-
eases — predispositions — who most
liable?— ^oes the diathesis accompa-
nying organic disease impair the fa-
culty of conception ? — does organic
disease affect the vitality of the off-
spring ? — inflammation of uterus-^
cause of sterility — ^use of ergot — simple
ulceration — diagnosis of— -specific cQs-
eases — ^malignant diseases — corroding
ulcer — treatment — melanosis — symp.
toms — post-mortem appearances -—
prognosis — diagnosis— treatment, 35.
Uterus, Pregnancy with Imperforate and
Bilocular, 85.
Uterus, Risks attending on Injections
into the, 285.
V.
Vaccination Latent for Three Years, 155.
Vagina, Case of Rupture of. Trial of a
Surgeon for Manslaughter, 322.
Valerianate of Zinc in Neuralgias and
Chronic Satyriasis, 281.
Valves, Inflammation of Columnae Car-
neae, a Cause of Insufliciency of, 155.
Variations in the Weight of Prisoners
subjected to the Regimen of a Peni-
tentiary, 341.
Variola, Iodine a Preservative against.
Mode of exhibition, 223.
Vegetable Diet, Letter on, 343.
Vegetations, Cryptogamic, in the Sto-
mach, 346.
Vitalism, Facts bearing on. Critical Exa-
mination of the, 399.
Vulva, Trial of Samuel Clark on a
charge of Murder, by stabbing in the.
By Dr W. Tait, 297.
W.
Walne^s Cases of Dropsical Ovaria re-
moved by the large Abdominal Sec-
tion, 320.
Walnut-leaves in several varieties of
Scrofulous Disease, 340.
Warden on the application of Prismatic
Reflection to the Investigation of Dis-
eases situated in the Open Cavities of
the Body, 210.
Water- brash, on the Occurrence of Sar-
cina Ventriculi along with Acetic,
Lactic, and Carbonic Acids in. By
G. Wilson, M.D., 182.
Watson, Dr T. Boswall, Case of Ex.
tensive Congenital Ulceration of the
Right Leg, 305.
Webster, A., M.D., Case of Imperforate
Hymen, 21.
Weight and comparative Length of Foe-
tus bom at the full time, 159.
Wilson, G., M.D., on the Occurrence of
Sarcina Ventriculi along with Acetic,
Lactic, and Carbonic Acids in Water-
brash, 182.
3h
426
INDEX.
Wilfon, Erasmus, on Diseases of the
Skin, 122.
Wood, Dr A., Notice of a Case of al-
leged Luminous Appearance on the
Hand and other Pans of the Body
before Death, 368.
Works on Analytical Chemistry, Notice
of, 213.
Wound in the Thorax ftom a common
Sewing Needle, 350»
Wound of the Heart, apparently Cured,
28a
Wright on Physical and Intellectual
Idfe, 273.
Zinc, Valerianate of, in Neuralgias and
in Chronic Satyriasis, 281.
END OF VOL. U
Printed by Oliver h fioytf,
tweeddale Court, High Street, EdinbuftfR.
NORTHERN JOURNAL OF MEDICINE.
The Editors beg leave to call the attention of the Profession to the
Contents of the first Volume of this Journal.
CONTENTS OF MAY NUMBER.
PART. I.— ORIGINAL ARTICLES.
On the Employment and Action of Digitalis in certain
Diaeases of the Heart. By William Hbndxrson,
M.D., Professor of General Pathology in the Uni-
versity of Edinburgh.
Dlustrations of Congenite Syphilis. By William
Campbell, M. D., Consulting Physician to the
Edinburgh Maternity Hospital, and Lecturer on
Midwifery, &c.
Case of Fatal Hemorrhage from Perforation of the
Aorta by False Teeth impacted in the (Esophagus.
By Jambs Duncan, M.D., Surgeon to the Royal
Infirmary of Edinburgh. (With a Plate.)
Case of Imperforate Hymen. By A. Wxbstkr, M.D.,
Physician to the Dundee Royal Infirmary.
Case of Congenital Ulceration and Gangrene. By
T. B. W. Potts, M.D., of Jersey.
On Sleep, and some of its Concomitant Phenomena.
Bdng the Substance of a Lecture delivered at the
RoyiU Institution of Manchester. By Lvon Play-
fair, Ph. D. of Manchester ; Translator of Liebig's
Chemistry of Agriculture and Physiology.
PART II.— REVIEWS.
Lbvbr on Organic Diseases of the Uterus.
Travbrs' Physiology of Infiammation.
PART III.— PERISCOPE.
Anatomy and Physiology — On the Structure, die. ,
of the Nervous System.
SuROBRY — Cancer of the Eyelids.
Matbria Mbdica and Dibtbtics— New Prepara-
tions of Iron.
Pathology and Practicb of Mxdicinb— Treat-
ment of Acute Rheumatism.
Midwifbry and Disbasbs of Wombn And Chil-
DRBN— <3rowth of New Bone on the Internal Sur-
face of the Cranium in Pregnant Females.
Pregnancy with Imperforate and Bilocular Uterus.
FoRBNSic Mbdicinx AND Mbdical PoLicB— Pro-
longed Pregnancy.
Toxicological Effects of Sulphate of duinine.
PART IV.— MEDICAL MEMORANDA.
The late Dr Andbbw Moir.
JUNE NUMBER.
PART L-ORIGINAL ARTICLES.
Condyloma, a Prbaiary Form of Venereal Disease
identical with Sibbens. Bv David Skab, M.D;,
Surgeon to the Edinburgh Lock Hospital.
Death by Rupture of the Lung from Eixtemal Vio-
lence. By William Tait, M.D., Surgeon to the
Edinburgh Police.
Curability of the more acute Form of Hydrocephalus,
in its earliest Stage, under active Treatment ; with
a Case. By Albxandbr Harvby, M.D., Lecturer
on the Institutes of Medidne in Marischal College
and University, Aberdeen.
Unusual Termination of a Case of Congenite Hydro-
cephalus. By William Campbbll, M.D., Lecturer
on Midwifery, &c., Edhibui^h.
Observations on Dr Campbbll's Paper on Congenite
^philis, in the First Number of this Journal. By
W. Acton, Esq., Surgeon to the IsUngton Dispen-
Death by Poisoning with the Leaves of Aconite. By
Albx. Ramsay, Esq., Surgeon, Broughty-Ferry.
PART n— REVIEWS.
Wilson on Diseases of the Skin.
Curling on Diseases of the Testes, &c.
PART III.— PERISCOPE.
Anatomy and Physiology— On the Structure, &c.,
of the Nervous System.
Experiments on the Mode by which Poisons are Ab-
sorbed.
SuRGKRY— General Laws of Displacement of Bones in
Fracture.
Aneurism of the Iliac Artery.
Matbria Mbdica and Dibtbtics— Inoculation with
Tartar Emetic.
Effect of Ergot of Rye in Palsy of the Lower Extre-
mities.
Pathology and Practicb of Mbdtcinb — Connexion
between Hydrocephalus and Disease of Lungs.
Inflammation of Columnae Camese.
Vaccination latent for Three Years.
Tartar Emetic as a Remedy for Syphilis.
loduret of Potassium in Saturnine Affections.
Midwifbry and Disbasbs of Wombn and Cuil-
DRBN— Pelvic Inflammation after Parturition.
Forbnsic Mbdicinb and Mbdical PoLicB-^Inhala-
tion of Oxygen an Antidote to Poisoning with Car-
bolic Acid.
Comparative Weight and Length of Foetus.
PART rv— MEDICAL MEMORANDA.
Edmburgh Maternity Hospital.
JULY NUMBER.
PART I.— ORIGINAL ARTICLES.
Cases of rare Mali^ant Dis^ue of the Ovary. By
J. C. W. Lbvbr, M.D., of Guy's Hospital, Author
of a Practical Treatise on Organic Diseases of the
Uterus.
Practical Observations on some of the Chronic Dis-
eases of the Stomach. By William Strangb,
M.D., of Ashton-under-Lyne.
On Perityphlitis, or Inflammation of the Cellular
Tissue adjacent to the Cscum. By William
Sbllbr, M.D., Lecturer on liateria Medica and
Dietetics, Edinburgh.
On the Occurrence of Sarcina Ventriculi along with
Acetic, Lactic, and Carbonic Adds in Water-Brash.
By Gbobgb Wilson, M.D., Lecturer on Chemistry,
Edinburgh.
PART n.— REVIEWS.
Lbb's Lectures on the Theory and Practice of Mid-
wifery.
Sir Charlbs Bbll's Anatomy and Philosophy of
Expression as connected with the Fine Arts.
8b> Oborgb Ballinoall's Remarks on Schools of
Instruction for Military and Naval Surgeons, &c.
Warden on the Application of " Prismatic Reflec-
tion " to the Investigation of Diseases situated in
the open Cavities of the Body.
Notice of Works on Analytical Chemistry.
PART III.— PERISCOPE.
Anatomy and Physiology— On the Structure, &c.,
of the Nervous System.
Surgery— " Keratoplastie."
Matbria Mbdica and Dibtbtics— On Skate-Liver
Oil.
Pathology and Practicb of Mbdicinb — Elephan-
tiasis in Norway.
Case of ElephantuuBis Cured by Guaiac and Iodine.
Cryptogami of the Hair.
Midwifbry and Disbasbs of Wombn athh Chil-
ORBN— Dr Oldham on Polypus Uteri.
Forbnsic Mbdicinb and Mbdical Policb— Iodine
a Preservative against Variola.
PART IV.— MEDICAL MEMORANDA.
How far is a Prisoner accused of Murder held guilt-
less provided the Deceased has a Surgical Operatlor
performed upon hJm ?
AUGUST NUMBER.
PART I.— ORiaiNAL ARTICLES.
Observations ou tbe Best Mode of Registerhig Deaths.
By William Pultbnky Alison, M.D., F.H.8.E.,
Professor of tbe Practice of Medicine in the Univer*
sity of Edinburgh.
On the Diagnosis and Treatment of Enlanement of the
Heart. By William Hxnokimon, M.D., Professor
of Medicine and (General Fbthology in the University
of EdinbiU]^
Two Cases oflcteras Gravis Infantum from Deficiency
of the Hepatic and Cystic Ducts, and one from flnn
Plugging of the Common Duct. By Alrxandrr
D. Campbxll, M<B., Ozon, F.R.C.S.E., and Phy-
sician-Accoucheur to the Royal Dispensary.
Practical Observations on some of the Chronic Dis-
eases of the Stomach. By William Stilanob,
M.D., M.R.C.S. Edin., Surgeon to the Ashton-
under-Lyne Dispoisary.
Curability of the more Acute Form of Hydrocephalus
In its earUest Stage and the Practicability of the
Diagnosis in the Generality of Cases. By Alkxandbr
Harvxy, M.D., Lecturer on the Institutes of Medi-
cine in Marischal College and University, Aberdeen.
PABT n— REVIEWS.
Thoughts on the Mental Functions.
PcRinr on tbe Sanitary State of Glasgow.
Wright on Physical and Intellectual Life.
RiOBY on Dysmenorrhcea, &c.
PART ni.— PERISCOPE.
Anatomy and Physiolooy— Doubto as to Kieman's
Views of the Structure of the Liver.
SuROBRY— On Excision of the Head of the Femur.
Case of Tetanus following the Mechanical Cure of a
Fistula Lachrymalis.
Wound of the Heart apparently Cured.
Matxria Mboica and DixTBTica— Valerianate of
Zinc in Neuralgias and in Chronic Satyriasis.
Pathology and Practicb of Mbdicinb— On the
Treatment of Syphilis by Mercui^ and Iodine.
Midwifbry and Dibxasbs of Wombn and Chii.-
DRBN— Risk attending on Injections into the Uterine
Cavity.
Use of the Tampon for the Cure of Utero- Vaginal
Blennorrhcea.
Trismus Neonatorum treated with Mask.
Kermee Mineral in Pleuro-Pnenmonia in Children.
On Testing the Qualities of a Nurse's MUk.
FoRBNBic Mbdicinb and Mxdical Policb— Means
of Correcting the Changes which take place in Rahi-
Water kept in Cisterns newly constructed with
Ume.
PART IV.— MEDICAL MEMORANDA.
On the Time required for the Transit of Coins and
the like through the Intestines when swallowed
accidentally.
SEPTEMBER NUMBER.
PART I.-ORIQINAL ARTICLES.
Case of Suspected Poisonhig by an Over-dose of
Tartar Emetic, sent out by a Non-professional
Dispenser. By Ebbnbsxr Skab, M.D.
Trial of Samuel Clark on a Charge of Murder by
Stabbing in the Vulva; with Remarks. By
William Tait. M.P.
Case of Extensive Congenital Ulceration of the
Right Leg. By T. BoawALL Watson. M.D.
Pregnancy complicated with Ovarian Enlargement*
By Samubl Sombrvillb, M.D.
Case of Congenital Syphilis, with Observations.
By William Stranob, M.D.
PART n.— REVIEWS.
A Bill for the better Regulation of Medical Practice
throughout the United Kingdom.
Walnr^s Cases of Dropsical Ovaria removed by
the Laiige Abdominal Section.
Trial of a Surgeon for Manslaughter: Case of
Rupture of the Vagina.
Bwxbtsbr's Mental Hygiene.
PART HL— PERISCOPE.
Anatomy and Physiology— Bernard's Researches
upon Alimentary Substances.
SvROBRY— Removal of Encysted Tumours from the
Eyelids.
Amputation of the Ankle Joint.
Matxria Mxoica and Dixtbtics— Walnut Leaves
in several Varieties of Scrofulous Disease.
Treatment of Gout and Rheumatism.
Variations hi the Weight of Prisoners subjected
to the R^lmen of a Penitentiary.
Letter on Vegetable Diet.
Pathology and Practicb of MxDiciifx— Alkaline
Treatment of Tuberculous Consumption.
New Method of Detecting Sugar in Diabetic Urine.
Composition of Chlorotic Blood and Urine, and
Effect of Ferruginous Preparations.
Cryptogamic Vegetations in the Stomach.
Midwifbry and Disbasbs of Wombn and Ohu.-
DRBN— Tincture of Opium in the Scrofulous Oph-
thalmia of Children.
Diarrlwea in Children treated with ](|]^eetion8 of
Nitrate of Silver.
On Eneuresls Nocturaa.
FoRBNSic Mbdicinb and Mbdical PoLiCB-*-Bta-
tistics of the TransmiMion of Insanity.
Wound in the Thorax from a common Sewing
Needle.
Death from the Paring of a Com.
PART IV.— MEDICAL MEMORANDA.
Modes of Evacuating the Stomach.
National Benevolent Institution — Mrs Collkn
Brown.
Fever in Irish Farm-houses.
OCTOBER NUMBER.
PART I.— ORIGINAL ARTICLES.
On Deafness from Hemorrhage into the Tympanum,
successfully treated by Perforation of the Membrane,
&C. 6lq. By Jambs Mbrcbr, M.D.
Caiaarian Section after the Death of tbe Parent. By
William Campbbll, M.D.
Case of alleged Luminous Appeaianoe of Parts of the
Body before Death. By Alxzanobr Wood,
M.D.
Surgical C a s e s— Nenralria of Stump after Amputation
—Secondary Amputation— Return of the Neuralgia.
By Jambs Duncan, M.D.
PART II.— REVIEWS.
1. Homceopathy Unmasked, bdng an Exposure of its
Principal Absurdities and Contradictions : with an
Estimate of its Recorded Cures. By Albzandbr
Wood, MD.. F.R.C.P., Ac &c
8. Defence of Hahnemann and his Doctrines : includ-
ing an Exposure of Dr Axbzandbr Wood's
•• Homceopathy Unmasked."
3. Sequel to Homoeopathy Unmasked ; befaig a farther
Exposure of Hahnemann and his Doctrmes, in a
Reply to recent Anonymous Pamphleteers. By
Alkxandbr Wood, M.D., dtc. &c.
4. A Medical Visit to Grafenberg in April and May
1843, for the Purpose of Investigating the Merits of
the Water-Cure Treatment. By Sir Charlxs
Scudamorb, M.D., F.R.S., Ac
PART III.— PERISCOPE.
Anatomy and Physiology— Critical Examination
of Facts bearing on Vitalism.
SuROBRY— On Vascular Tumour of the Female
Urethra.
Two Cases of Imperforate Anus.
Matxria Mbdica and Dixtktics— On the Passage
of Certain Medichies into the Animal Economy.
New Cement for the Teeth.
Pathology and Practicb of Msdicinx— Recent
Additions to Patholoey.
New Diagnostk Sign of Typhoid DiseaseSi
Novel Remedies.
Midwifbry and D(bxasxs of Wombn and Chil-
DRBN— Extracts on Various Interesting Salgeets.
Forbnsic Mbdicinb and Mbdical Policb— Death
i^ter AdminiBtration of Repeated Doses of Phos-
phorus.
Foreign Body accidentally lodged in the Larynx.
PART IV.— MEDICAL MEMORANDA.
Effects of Revaccination in the Prussian Army.
Prescriptions
Graduations at Edinburgh.
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